Improving Collaborative Management of Multiple Mental and Physical Health Conditions: A Qualitative Inquiry into Designing Technology-Enabled Services for Eliciting Patients' Values.

People with multiple chronic conditions (MCC) face challenges planning health care collaboratively with primary care clinicians, particularly when their priorities conflict. These challenges intensify with symptoms of anxiety or depression. Elicitation of patients' values is promoted as a means to aligning patient and clinician priorities in primary care, and as a component of psychotherapy for anxiety and depression.

Worry and rumination elicit similar neural representations: neuroimaging evidence for repetitive negative thinking.

Repetitive negative thinking (RNT) captures shared cognitive and emotional features of content-specific cognition, including future-focused worry and past-focused rumination. The degree to which these distinct but related processes recruit overlapping neural structures is undetermined, because most neuroscientific studies only examine worry or rumination in isolation. To address this, we developed a paradigm to elicit idiographic worries and ruminations during an fMRI scan in 39 young adults with a range of trait RNT scores.

A digital intervention for cognitive deficits following COVID-19: a randomized clinical trial.

Post-COVID-19 cognitive deficits are common, persistent, and disabling. Evidence on effective treatments is limited. The goal of this study was to investigate the efficacy of a digital intervention to reduce cognitive and functional deficits in adults with persistent post-COVID-19 cognitive dysfunction.

Real-time cognitive performance metrics derived from a digital therapeutic for inattention predict ADHD-related clinical outcomes: Replication across three independent trials of AKL-T01.

AKL-T01 is a digital therapeutic (DTx) that targets attention by generating conflict at dynamically updated difficulty levels during a multitasking game. Clinical trials support AKL-T01's efficacy in attention-deficit/hyperactivity disorder (ADHD), but there is a need to understand how in-game data can be used to monitor patient changes in cognition. We aimed to derive a real-time measure of attention from AKL-T01 gameplay data and validate it against clinical outcomes.

Two single arm trials of AKL-T01, a digital therapeutic for adolescents and adults with ADHD.

Inattention symptoms represent a key driver of functional impairment in ADHD and often persist into adolescence and adulthood, underscoring a need for novel treatments targeting attentional control. We evaluated AKL-T01-a digital therapeutic that is FDA-cleared for children 8-12 y with ADHD-in adolescents and adults with ADHD in two independent single-arm trials: STARS-ADHD-Adolescent, a 4-week trial in adolescents 13-17 y (n = 162 enrolled), and STARS-ADHD-Adult, a 6-week trial in adults 18 and older (n = 221 enrolled). AKL-T01 was linked with improvements on the Test of Variables of Attention (TOVA) Attention Comparison Score (ACS) of 2.

Measuring algorithmic bias to analyze the reliability of AI tools that predict depression risk using smartphone sensed-behavioral data.

AI tools intend to transform mental healthcare by providing remote estimates of depression risk using behavioral data collected by sensors embedded in smartphones. While these tools accurately predict elevated depression symptoms in small, homogenous populations, recent studies show that these tools are less accurate in larger, more diverse populations. In this work, we show that accuracy is reduced because sensed-behaviors are unreliable predictors of depression across individuals: sensed-behaviors that predict depression risk are inconsistent across demographic and socioeconomic subgroups.

Longitudinal associations of daily affective dynamics with depression, generalized anxiety, and social anxiety symptoms.

Background: Low average affect, measured using ecological momentary assessment (EMA), has been consistently linked with depression, generalized anxiety, and social anxiety, supporting trait-like negative affect as a shared underlying feature. However, while theoretical models of emotion regulation would also implicate greater variability in daily affect in these conditions, empirical evidence linking EMA of mood variability with affective disorders is mixed. We used multilevel modeling to test relationships of daily mood and mood variability with depression, generalized anxiety, and social anxiety symptoms.

Specific associations of passively sensed smartphone data with future symptoms of avoidance, fear, and physiological distress in social anxiety.

Background: Prior literature links passively sensed information about a person's location, movement, and communication with social anxiety. These findings hold promise for identifying novel treatment targets, informing clinical care, and personalizing digital mental health interventions. However, social anxiety symptoms are heterogeneous; to identify more precise targets and tailor treatments, there is a need for personal sensing studies aimed at understanding differential predictors of the distinct subdomains of social anxiety.

From formative design to service-ready therapeutic: A pragmatic approach to designing digital mental health interventions across domains.

As digital mental health interventions (DMHIs) proliferate, there is a growing need to understand the complexities of moving these tools from concept and design to service-ready products. We highlight five case studies from a center that specializes in the design and evaluation of digital mental health interventions to illustrate pragmatic approaches to the development of digital mental health interventions, and to make transparent some of the key decision points researchers encounter along the design-to-product pipeline. Case studies cover different key points in the design process and focus on partnership building, understanding the problem or opportunity, prototyping the product or service, and testing the product or service.

A text messaging intervention to support the mental health of young adults: User engagement and feedback from a field trial of an intervention prototype.

Background: Young adults have high rates of mental health conditions, but most do not want or cannot access treatment. By leveraging a medium that young adults routinely use, text messaging programs have potential to keep young adults engaged with content supporting self-management of mental health issues and can be delivered inexpensively at scale. We designed an intervention that imparts strategies for self-managing mental health symptoms through interactive text messaging dialogues and engages users through novelty and variety in strategies (from cognitive behavioral therapy, acceptance and commitment therapy, and positive psychology) and styles of interaction (e.

Analyzing text message linguistic features: Do people with depression communicate differently with their close and non-close contacts?

Background: Relatively little is known about how communication changes as a function of depression severity and interpersonal closeness. We examined the linguistic features of outgoing text messages among individuals with depression and their close- and non-close contacts.

Methods: 419 participants were included in this 16-week-long observational study.

Emotion-related impulsivity across transdiagnostic dimensions of psychopathology.

Objective: Several dimensions have received attention for their potential role in explaining shared variance in transdiagnostic symptoms of psychopathology. We hypothesized emotion-related impulsivity, the trait-like tendency toward difficulty restraining responses to emotion, would relate to symptoms of psychopathology, with two separable dimensions of emotion-related impulsivity relating distinctly to internalizing and externalizing symptoms.

Method: Across two studies, we tested hypotheses using structural equation models of emotion-related impulsivity and multiple indicators of internalizing, externalizing, and thought symptoms.

Negative interpretation bias connects to real-world daily affect: A multistudy approach.

Negative interpretation bias, the tendency to appraise ambiguous stimuli as threatening, shapes our emotional lives. Various laboratory tasks, which differ in stimuli features and task procedures, can quantify negative interpretation bias. However, it is unknown whether these tasks globally predict individual differences in real-world negative (NA) and positive (PA) affect.

The association of language style matching in text messages with mood and anxiety symptoms.

Context: Impairment in social functioning is a feature and consequence of depression and anxiety disorders. For example, in depression, anhedonia and negative feelings about the self may impact relationships; in anxiety, fear of negative evaluation may interfere with getting close to others. It is unknown whether social impairment associated with depression and anxiety symptoms is reflected in day-to-day language exchanges with others, such as through reduced language style matching (LSM).

Prospective associations of text-message-based sentiment with symptoms of depression, generalized anxiety, and social anxiety.

Objective: Language patterns may elucidate mechanisms of mental health conditions. To inform underlying theory and risk models, we evaluated prospective associations between in vivo text messaging language and differential symptoms of depression, generalized anxiety, and social anxiety.

Methods: Over 16 weeks, we collected outgoing text messages from 335 adults.

Insights Into Needs and Preferences for Mental Health Support on Social Media and Through Mobile Apps Among Black Male University Students: Exploratory Qualitative Study.

Background: Black college-aged men are less likely than their peers to use formal, therapeutic in-person services for mental health concerns. As the use of mobile technologies and social media platforms is steadily increasing, it is important to conduct work that examines the future utility of digital tools and technologies to improve access to and uptake of mental health services for Black men and Black men in college.

Objective: The aim of this study was to identify and understand college-attending Black men's needs and preferences for using digital health technologies and social media for stress and mental health symptom management.

Identifying real-world affective correlates of cognitive risk factors for internalizing disorders.

Cognitive risk factors are key in the vulnerability for internalizing disorders. Cognitive risk factors modulate the way individuals process information from the environment which in turn impacts the day-to-day affective experience. In 296 young adults, we assessed two transdiagnostic, general risk factors-repetitive negative thinking (RNT) and anxiety sensitivity in a high-RNT subsample ( = 119).

Situational uncertainty interacts with anxiety sensitivity and distress intolerance to predict anticipated worry and preparation for a hurricane.

Background: There is evidence for the impact of emotional intolerance on reactivity to stressors, but it is unknown whether the level of situational uncertainty may moderate this relationship. We examined whether situational uncertainty moderated the relationship between emotional intolerance and anticipated anxious responding to hurricane forecasts, considering three aspects of emotional tolerance: anxiety sensitivity, distress intolerance, and hurricane-specific distress intolerance.

Methods: Participants (N = 358) were Florida residents who experienced Hurricane Irma.

A Spanish translation of the Hoarding Rating Scale: Differential item functioning and convergent validity.

Hoarding disorder (HD) involves extreme difficulties discarding possessions and significant clutter in living areas. Although hoarding occurs worldwide, cross-cultural research remains in nascent stages, hampered in part by a lack of validated measures in non-English languages. We aimed to validate a Spanish translation of the Hoarding Rating Scale (HRS), a widely used measure of core HD symptoms.

A longitudinal investigation of COVID-19 pandemic experiences and mental health among university students.

Objectives: Previous studies have established a link between the COVID-19 pandemic and poor mental health. They further suggest that young adults may be especially vulnerable to worsened mental health during the pandemic, but few studies have investigated which specific aspects of the COVID-19 experience affect psychological well-being over time. To better understand concrete predictors of poor mental health outcomes in this population, we identified several pandemic-related experiences and evaluated their effects on mental health symptoms (depression, anxiety, stress, alcohol, and substance use) in a sample of U.

The distribution of daily affect distinguishes internalizing and externalizing spectra and subfactors.

There has been increasing recognition that classically defined psychiatric disorders cluster hierarchically. However, the degree to which this hierarchical taxonomy manifests in the distribution of one's daily affective experience is unknown. In 462 young adults, we assessed psychiatric symptoms across internalizing and externalizing disorders and then used cell-phone-based ecological momentary assessment (EMA) to assess the distribution (mean, standard deviation, skew, kurtosis) of one's positive and negative affect over 3-4 months.