Frederike Schirmbeck

Background: Childhood trauma increases the risk for psychosis. However, mechanisms underlying this relationship remain unclear. In the present study, we aimed to investigate whether negative cognitive self-schemas or basic self-disturbance mediate the association between childhood trauma subtypes (abuse and neglect) and psychotic experiences in patients with psychotic disorders, unaffected siblings, and healthy controls. Methods: This study was performed in a subsample of 110 patients, 120 siblings, and 48 healthy controls within the Genetic Risk and Outcome of Psychosis (GROUP) study. Parallel mediation models were used while correcting for age and sex. Abuse and neglect were measured with the childhood trauma questionnaire (CTQ), psychotic experiences with the Community Assessment of Psychic Experiences (CAPE), self-disturbance phenomena with the Self-Experience Lifetime Frequency Scale (SELF), and negative self-schemas with the Brief Core Schemas Scale (BCSS). Results: In patients, negative self-schemas fully mediated the association between abuse and psychotic experiences, whereas self-disturbance partly mediated the effect of neglect on psychotic experiences. In siblings, both negative self-schemas and self-disturbance fully mediated the association between abuse/neglect and psychotic experiences. In controls, only negative self-schemas mediated the association between abuse and neglect and psychotic experiences. Conclusions: Our findings suggest that negative self-schemas and self-disturbance phenomena are relevant factors in explaining the association between childhood trauma and psychotic experiences across illness liability groups. Further research is needed to explore the causal pathways between trauma, negative self-schemas, self-disturbance phenomena, and psychotic experiences.

Introduction: Monitoring of population mental health is now considered to play a vital role in health, risk factor and demographic surveillance systems across the globe. Adopting a public mental health perspective on monitoring and surveillance requires us to consider the entire spectrum of mental health, which broadly ranges from positive mental health and well-being to severe mental disorders, including at-risk populations. This population mental health approach has become the mainstay of public mental health provision in many European countries but there is a dearth of research on this issue in Germany in the past 20 years and fundamental conceptual and methodological issues remain to be addressed at both the national and international levels. Methods and analysis: The Mannheim incidence and inception cohort study is a recently established two-arm population-based incidence (arm 1) and inception cohort (arm 2) study in the catchment area of Mannheim, Germany. In the incidence-arm, case ascertainment of incident cases is carried out for the years of 2024 and 2025 based on clinical assessment via structured clinical interviews and retrospective case record evaluation. In the inception cohort arm, we recruit and follow an epidemiologically characterised population-based cohort of individuals (1) without symptoms (ie, stage 0), (2) meeting the criteria for non-specific psychological distress (ie, stage 1 a) or (3) a Clinical High At-Risk Mental State for severe mental disorder (ie, stage 1b) at baseline and up to four follow-up assessments every 6 months. Assessments include clinical interviews, self-report measures and ecological momentary assessment. Poisson regression will be conducted to quantify variation in incident rates by age, sex and migrant/ethnic minority group status. In the inception cohort arm, we will perform maximum likelihood estimation of hazard rates to estimate rates of transition from earlier stages to later stages. Latent class analysis will be used to identify empirically-based clinical stages to test convergence with contemporary staging models. Ethics and dissemination: The study has received ethical approval from the local ethics committee (Medical Faculty Mannheim, Heidelberg University, 585-21). Results will be published in peer-reviewed journals, presented at academic conferences and disseminated through (social) media to address a broader public audience.

Background: The duration of untreated psychosis (DUP) is still considerably long in patients with psychotic disorders worldwide. Social determinants, such as the socioeconomic status, can influence DUP, exacerbating health inequalities in access to timely care. We investigated whether subpopulations with shared characteristics are associated with longer DUP. Methods: We performed latent class analyses to investigate whether classes with shared configurations of social and substance use-related risks can be identified in two large cohorts with psychotic disorders: N = 780 patients from the GROUP project and N = 847 patients from the EU-GEI project. Subsequently, we conducted survival analyses to analyze whether identified classes are associated with DUP. Results: We identified three classes in both samples. Membership of the class with predominantly younger men, higher proportion of cannabis use, and supported living was associated with longer DUP compared with a class with predominantly White ethnicity, higher education, and current employment in GROUP (HR = 1.28, 95% CI: 1.06–1.56, p = .011) and in EU-GEI (HR = 1.27, 95% CI: 1.07–1.51, p = .007). In GROUP, membership of a third class with predominantly White women, without cannabis use, was associated with the shortest DUP (HR = 0.78, 95% CI: 0.63–0.95, p = .016). Conclusions: Results suggest that specific populations differ in their risk distributions for prolonged DUP and highlight the importance of considering configurations of social determinants in context. Public mental health programs need to establish their differential impact for diverse populations and facilitate more targeted pathways to care.

Introduction: This study examined 1) long-term effects of SELFIE, a transdiagnostic blended ecological momentary intervention (EMI) for improving self-esteem at 18- and 24-month follow-up, and 2) whether SELFIE’s effects on general psychopathology are mediated via self-esteem. Methods: A 2-arm, parallel-group, assessor-blinded, Dutch multi-center randomized controlled trial (RCT) was conducted between 2018-2022. Participants aged 12-26 years with prior exposure to childhood adversity and low self-esteem were randomized to a blended EMI (app-based and face-to-face) plus care as usual (CAU) or to CAU only. Measures included global, positive, and negative self-esteem, schematic self-beliefs, quality of life, general psychopathology, momentary self-esteem and affect, assessed at post-intervention, 6-month, 18-month, and 24-month follow-up. Results: 174 participants were randomized. 1) Across 18- and 24-month follow-up, participants in the experimental compared to control condition showed higher global self-esteem (B=2.12, 95% CI [0.80, 3.45], d=0.46). Small to moderate long-term effects were observed on positive and negative self-esteem, positive schematic self-beliefs, and social quality of life (18- and 24-month), as well as momentary self-esteem (18-month), and general psychopathology (24-month). 2) Effects on general psychopathology at post-intervention (B=-19.0, 95% CI [-31.6, -8.5], proportion mediated (PM)=86.8%) and 6-month follow-up (B=-15.1, 95% CI [-26.0, -6.2], PM=66.7%) were mediated via changes in global self-esteem. Additional mediators were positive and negative self-esteem, positive and negative schematic self-beliefs. Conclusion: Results demonstrate long-term efficacy signals of SELFIE on self-esteem, psychopathology, and quality of life. Short-term effects on general psychopathology were partly mediated via self-esteem. Further research on SELFIE’s implementation, scalability, and public health impact is warranted.

Young adults with severe mental illness (SMI) often face significant barriers to accessing mental health care, including (self)-stigmatization, social withdrawal, and a lack of appropriate treatment programs. These challenges underscore the need for recovery-oriented interventions tailored to the developmental needs of this population. The aim of this study was to evaluate Acceptance and Commitment Therapy (ACT), with its focus on psychological flexibility and values-based action, for young adults with SMI. This pre-post pilot evaluation assessed the indications for feasibility, and preliminary outcomes of The Young Ones (TYO), an eight-week, ACT-based, transdiagnostic group intervention designed for young adults with SMI. Outcomes included personal recovery, functional impairment, psychological flexibility, and self-stigmatization. To evaluate change over time, we conducted separate Linear Mixed Models (LMM) for each outcome measure using an intention-to-treat (ITT) approach. Of 101 eligible participants, sixty-one individuals enrolled in the research, and 33 completed both pre- and post-measures (46% attrition). Significant improvements were observed in personal recovery and functional impairment. No significant changes were found for psychological flexibility or self-stigmatization. TYO appears feasible and acceptable for young adults with SMI, with promising indications of benefit in personal recovery and daily functioning. While dropout remains a concern, these preliminary findings support the need for a randomized controlled trial to rigorously evaluate the effectiveness of ACT-based group interventions for this population.

Background: Tobacco smoking is highly prevalent in patients with psychosis, who also often experience negative affect (NA) and stress. The relationship between these factors remains unclear in this population. We aimed to investigate everyday life associations in 158 patients with psychosis, 136 unaffected siblings, and 117 controls from the Genetic Risk and Outcome of Psychosis (GROUP) study with Experience Sampling Method measurements. Methods: Generalized linear mixed models were used to evaluate across time and within-subject associations. Across time analyses investigated the relationship between smoking status and overall NA and stress. Within-subject analyses assessed whether smoking between two measurements ( t ₋₁ and t ₀ ) was associated with changes in NA and stress at the measurement after smoking a cigarette ( t ₀ ) and at the subsequent measurement ( t ₊₁ ). Results: Across assessments, smoking status was initially associated with NA in patients ( B =0.26, p =0.036), but this association disappeared after controlling for psychotic symptoms and cannabis use. Within-subject analyses in smokers showed a decrease in NA in patients after smoking ( t ₀ : −0.23, p =0.016), which remained significant after correcting for confounders ( t ₀ : −0.20, p =0.015). Siblings showed a decrease in NA ( t ₀ : −0.22, p =0.009), also after controlling for confounders ( t ₀ : −0.14, p =0.018). No time-lagged effect was found at t ₊₁ after correction for subsequent smoking. Conclusions: Overall smoking behavior was not associated with NA in patients with psychosis. In the short term, smoking in the daily life context is associated with a reduction in NA in people vulnerable to psychosis, possibly due to alleviation of withdrawal symptoms, which may complicate smoking cessation.

Background: Efforts in mental health research have long focused on the care and long-term outcomes of mental disorders. More recently, a shift in focus has occurred toward mental health promotion and prevention. One priority target population for promotion and prevention is youth with climate change–related distress. In light of the real-world threat of climate change, adaptive emotion regulation and engagement in meaningful action are 2 important strategies for promoting mental health. Ecological momentary interventions (EMIs) allow for the delivery of accessible interventions for young people with climate change–related distress, but evidence on their feasibility or beneficial effects is currently lacking. Objective: We aimed to examine the feasibility and initial signals of efficacy of the Climate Mind and Act (CliMACT) training, a novel hybrid EMI for mental health promotion in youth with climate change–related distress. Methods: A 2-arm, parallel-group, and assessor- and analyst-blinded feasibility randomized controlled trial (RCT) will be conducted in 50 young people aged 14-25 years with climate change–related distress, who will be allocated on a 1:1 ratio to the experimental condition (CliMACT training + care as usual [CAU]) or the control condition (CAU only). CliMACT involves 3 sessions with a mental health professional and 6-week access to a smartphone-based EMI to support the real-world transfer of training content based on compassion-focused interventions and acceptance and commitment therapy. The EMI delivery schemes involve enhancing (introducing new EMI components), consolidating (training of EMI components), and adaptive (triggered in moments of higher negative affect) components. CAU involves access to all standard health care and social services. Feasibility criteria of the trial methodology include recruitment, randomization, and retention. Feasibility outcomes of delivering the CliMACT training include participant satisfaction, participant adherence, and mental health professionals’ fidelity to the training protocol. Initial signals of efficacy on mental health candidate outcomes and mechanisms will be explored. As feasibility criteria for a priori planned subgroup analyses, credibility criteria will be established and distributions of indicators for health inequities explored. Feasibility criteria for measuring costs of care and service use and health-related quality of life for an economic evaluation in a future definitive RCT will include exploring response distributions across groups. Candidate outcomes and mechanisms will be assessed at baseline, post training, and 4-week follow-up, using self-report and 6 days of ecological momentary assessment. Results: The first enrollment took place in December 2024. Data collection was completed by August 25, 2025. Results are expected for publication in 2026. Conclusions: To our knowledge, this is the first study to establish the feasibility and initial signals of efficacy of an EMI, targeted specifically at young people with climate change–related distress. If feasibility can be established, the trial will inform a future fully powered efficacy-effectiveness RCT, accompanied by an economic evaluation. Trial Registration: ISRCTN ISRCTN33613914; https://doi.org/10.1186/ISRCTN33613914 International Registered Report Identifier (IRRID): DERR1-10.2196/77764

Background and objective: In recent years, growing scientific and public awareness has highlighted the negative impacts of climate change on mental health, particularly among young people, who are disproportionately affected. These findings underscore the need for effective and scalable interventions to support individuals experiencing climate change-related distress (CCD). At the initial stage, it is crucial to understand how this distress manifests and what the momentary risk and protective factors are that exacerbate and modulate its dynamic occurrence in everyday life. Methods: In this context of need, nine qualitative, semistructured interviews with young individuals, aged between 14 and 25 and living in Germany, with CCD were conducted. Interviews centred on individuals’ burdens, putative triggers eliciting the experience, as well as putative protective factors. We analysed the data and developed themes via Braun and Clarke’s reflexive thematic analysis and electively structured the analysis according to the coding paradigm adopted from Strauss and Corbin. Results: Participants reported experiencing a wide range of negative emotions as well as mental health difficulties associated with climate change, including sleep disturbances, reduced well-being and difficulties concentrating. The experience emerges from the understanding and awareness of the complexity of climate change and its associated consequences for the environment. Protective factors were reported, including positive emotions (eg, hope, finding meaning and purpose), self-efficacy, conceptual knowledge about climate change-related emotions and external factors (ie, social support). Participants employed various strategies to regulate their emotions, ranging from avoidance and distraction to strategies like acceptance, cognitive reappraisal and active engagement in pro-environmental behaviour or activism. Conclusion and clinical implications: Overall, this study enhances our understanding of young individuals’ emergence and daily life experience of CCD. The findings suggest that a prolonged or overly extensive occurrence may result in mental health difficulties. Moreover, the results highlight the importance of strengthening factors associated with resilience at a young age, enabling individuals to cope with CCD. The findings have implications for the development of potential intervention components and suggest imparting conceptual knowledge and adaptive regulatory strategies, supporting habit formation and providing networking opportunities with others affected by CCD.

BACKGROUND Efforts in mental health research have long focused on the care and long-term outcomes of mental disorders. More recently, a shift in focus has occurred toward mental health promotion and prevention. One priority target population for promotion and prevention is youth with climate change–related distress. In light of the real-world threat of climate change, adaptive emotion regulation and engagement in meaningful action are 2 important strategies for promoting mental health. Ecological momentary interventions (EMIs) allow for the delivery of accessible interventions for young people with climate change–related distress, but evidence on their feasibility or beneficial effects is currently lacking. OBJECTIVE We aimed to examine the feasibility and initial signals of efficacy of the Climate Mind and Act (CliMACT) training, a novel hybrid EMI for mental health promotion in youth with climate change–related distress. METHODS A 2-arm, parallel-group, and assessor- and analyst-blinded feasibility randomized controlled trial (RCT) will be conducted in 50 young people aged 14-25 years with climate change–related distress, who will be allocated on a 1:1 ratio to the experimental condition (CliMACT training + care as usual [CAU]) or the control condition (CAU only). CliMACT involves 3 sessions with a mental health professional and 6-week access to a smartphone-based EMI to support the real-world transfer of training content based on compassion-focused interventions and acceptance and commitment therapy. The EMI delivery schemes involve enhancing (introducing new EMI components), consolidating (training of EMI components), and adaptive (triggered in moments of higher negative affect) components. CAU involves access to all standard health care and social services. Feasibility criteria of the trial methodology include recruitment, randomization, and retention. Feasibility outcomes of delivering the CliMACT training include participant satisfaction, participant adherence, and mental health professionals’ fidelity to the training protocol. Initial signals of efficacy on mental health candidate outcomes and mechanisms will be explored. As feasibility criteria for a priori planned subgroup analyses, credibility criteria will be established and distributions of indicators for health inequities explored. Feasibility criteria for measuring costs of care and service use and health-related quality of life for an economic evaluation in a future definitive RCT will include exploring response distributions across groups. Candidate outcomes and mechanisms will be assessed at baseline, post training, and 4-week follow-up, using self-report and 6 days of ecological momentary assessment. RESULTS The first enrollment took place in December 2024. Data collection was completed by August 25, 2025. Results are expected for publication in 2026. CONCLUSIONS To our knowledge, this is the first study to establish the feasibility and initial signals of efficacy of an EMI, targeted specifically at young people with climate change–related distress. If feasibility can be established, the trial will inform a future fully powered efficacy-effectiveness RCT, accompanied by an economic evaluation. CLINICALTRIAL ISRCTN ISRCTN33613914; https://doi.org/10.1186/ISRCTN33613914 INTERNATIONAL REGISTERED REPORT DERR1-10.2196/77764

Background: Acceptance and commitment therapy (ACT) is promising in the treatment of early psychosis. Augmenting face-to-face ACT with mobile health ecological momentary interventions may increase its treatment effects and empower clients to take treatment into their own hands. Objective: This study aimed to investigate and predict treatment engagement with and acceptability of acceptance and commitment therapy in daily life (ACT-DL), a novel ecological momentary intervention for people with an ultrahigh risk state and a first episode of psychosis. Methods: In the multicenter randomized controlled trial, 148 individuals with ultrahigh risk or first-episode psychosis aged 15-65 years were randomized to treatment as usual only (control) or to ACT-DL combined with treatment as usual (experimental), consisting of 8 face-to-face sessions augmented with an ACT-based smartphone app, delivering ACT skills and techniques in daily life. For individuals in the intervention arm, we collected data on treatment engagement with and acceptability of ACT-DL during and after the intervention. Predictors of treatment engagement and acceptability included baseline demographic, clinical, and functional outcomes. Results: Participants who received ACT-DL in addition to treatment as usual (n=71) completed a mean of 6 (SD 3) sessions, with 59% (n=42) of participants completing all sessions. App engagement data (n=58) shows that, on a weekly basis, participants used the app 13 times and were compliant with 6 of 24 (25%) notifications. Distribution plots of debriefing scores (n=46) show that 85%-96% of participants reported usefulness on all acceptability items to at least some extent (scores ≥2; 1=no usefulness) and that 91% (n=42) of participants reported perceived burden by number and length of notifications (scores ≥2; 1=no burden). Multiple linear regression models were fitted to predict treatment engagement and acceptability. Ethnic minority backgrounds predicted lower notification response compliance (B=–4.37; P=.01), yet higher app usefulness (B=1.25; P=.049). Negative (B=–0.26; P=.01) and affective (B=0.14; P=.04) symptom severity predicted lower and higher ACT training usefulness, respectively. Being female (B=–1.03; P=.005) predicted lower usefulness of the ACT metaphor images on the app. Conclusions: Our results corroborate good treatment engagement with and acceptability of ACT-DL in early psychosis. We provide recommendations for future intervention optimization. Trial Registration: OMON NL46439.068.13; https://onderzoekmetmensen.nl/en/trial/24803