Arne Popma

BACKGROUND The COVID-19 lockdown accelerated the adoption of telepsychiatry, including synchronous videoconferencing in adult mental health care. It is still unclear whether videoconferencing works equally well for all user groups. This study examines clinicians’ and clients’ experiences with videoconferencing during the first Dutch lockdown (April 2020) and one year later (April 2021), focusing on the appraisal of online individual (OIT) and online group treatment (OGT) in outpatient adult mental health care, covering first-line (primary) and second-line (specialized) services. OBJECTIVE To examine the appraisal of OIT and OGT among clients and clinicians in 2020 and 2021, and to explore subgroup differences by gender, age and diagnosis/profession. METHODS Two independent cross-sectional surveys were conducted in 2020 (clients: n = 350; clinicians: n = 146) and 2021 (clients: n = 357; clinicians: n = 122) at a Dutch mental health service. Participants evaluated their OIT and OGT experiences using newly developed service-evaluation questionnaires. For the appraisal score, we only used items that explicitly compared videoconferencing with face-to-face (FTF) care; principal axis factoring was used to derive appraisal scores. Hierarchical regression tested the added predictive value of survey year for appraisal of videoconferencing: step 1 included participant variables (gender, age, diagnosis/profession), and step 2 added survey year. Exploratory subgroup analyses examined within-year variation in appraisal by gender, age, and diagnosis/profession. RESULTS Despite a prevailing preference for FTF treatment, clients reported significantly higher appraisal with OIT in 2021 compared to 2020 (B = 0.22, P = .001), while appraisal of OGT did not differ significantly between years. Clinicians reported higher appraisal in 2021 than in 2020 for both OIT (B = 0.69, P < .001) and OGT (B = 1.40, P = .003). Exploratory subgroup analyses based on gender, age, or diagnosis found no meaningful differences in appraisal for either clients or clinicians. CONCLUSIONS Appraisal of videoconferencing was higher in 2021 than in 2020, most clearly among clinicians, yet both clients and clinicians still preferred FTF care on average. At present, videoconferencing appears best suited as a complementary option, with relevance for expanding access to mental health care globally in a rapidly changing landscape.

Background: Throughout years of research, the well-known behavioral parent training program, Parent-Child Interaction Therapy (PCIT), has been adapted and enhanced to tailor the treatment to the needs of families in community-based clinical care. This study wished to evaluate an add-on to PCIT that could be engaging for parents. As a way to enlarge practice opportunity and potentially allow parents to achieve positive treatment effects sooner, this study added virtual reality (VR) to PCIT. Objective: This study aimed to increase positive parenting skills at a faster pace with the use of PCIT-VR, on the basis that practicing positive parenting skills in the VR tool would increase parents’ overall practice time, thus leading to more confidence in their skills, which could consequently increase the pace of skill acquisition. Furthermore, we hypothesized that due to the overall increase in positive parenting skills, PCIT treatment effects such as diminishment of child disruptive behavior and parenting stress would decrease at a faster pace when VR was introduced. Methods: Families were recruited from a specialized child and adolescent psychiatry clinical practice in the Netherlands. Using a single-case experimental design, 11 families, equating to 18 participants, signed informed consent forms and received the staggered introduction of VR to treatment. As is common with a single-case experimental design, visual inspection analyses and randomization tests were conducted. Group differences were evaluated with nonparametric tests and reliable change indices. Results: Overall, our study reaffirmed that PCIT is an effective intervention for this population as there were positive treatment effects found in almost all cases. Nevertheless, there did not seem to be a clear relationship between the use of the VR tool and PCIT treatment effects, although positive parenting skills seemed to increase when VR was introduced to treatment for some parents. For all parents, questions and comments decreased with the introduction of VR. These findings tentatively suggest that practicing with VR could potentially increase positive parenting skills and also have an impact on other treatment-related outcomes, such as child disruptive behavior and parenting stress. Conclusions: This was the first time that PCIT has been supplemented with VR. We provide preliminary evidence of its added value. We cautiously suggest that VR could provide added value to PCIT and increase confidence in parenting skills for certain parents, although there are complex factors that play into treatment success that must simultaneously be considered. These factors include parents having the motivation and mental capacity to change and the complex psychological problems some families face. Although promising, we believe that due to the novelty of our VR practice tool and the variety of results from our study, more research is necessary into PCIT-VR to draw further conclusions on its effects.

Background: Difficulties in emotion regulation are a significant contributing factor to delinquent behavior in adolescence. These adolescents struggle with recognizing, comprehending, and controlling emotions, which impedes the effectiveness of current forensic treatments. In addition, forensic care often faces challenges regarding treatment engagement due to a lack of motivation and difficulties building an alliance between clients and caregivers. The use of Feelee, an app that collects and displays active and passive data, is promising to support adolescents in obtaining more insight into their emotion regulation abilities. Furthermore, the integration of smartphone apps, like Feelee, offers new perspectives to increase adolescents’ engagement and adherence to treatment. Objective: This study presents the research protocol for evaluating the initial effects of the Feelee app on emotion regulation among adolescents in the forensic outpatient setting. The Feelee app integrates with treatment as usual, and the multiple single-case experimental design methodology is discussed in detail. Methods: A multiple single-case experimental ABA design was applied to examine the initial effectiveness of Feelee. A total of 24 participants from 2 forensic outpatient care centers completed a 2-week baseline (phase A1), 4-week intervention (phase B), and a 2-week follow-up (phase A2). The primary outcome, emotional regulation, is measured daily using self-reports via the smartphone. Secondary outcomes, including emotional differentiation, insight and self-reflection, emotional awareness, and treatment-related factors such as motivation and therapeutic alliance, are assessed through questionnaires administered at preintervention, postintervention, and follow-up points. Quantitative analyses follow single-case experimental design methods, including visual analysis of individual trajectories, standardized mean difference permutation distance tests, and Cohen d at the group level. A 95% CI is calculated per participant to assess change reliability. Secondary outcomes are analyzed using the Reliable Change Index. Qualitative follow-up interviews are analyzed using thematic analysis at both the individual and group levels. Results: Data collection started in June 2023 and was completed in January 2025. By the time of final manuscript submission, 89 participants had been recruited and 24 had enrolled in the study. Study results will be published in peer-reviewed journals and presented at national and international conferences throughout 2025 Conclusions: This study aims to evaluate the effectiveness of the Feelee app in enhancing emotion regulation skills. By using a multiple single-case experimental ABA design, we will get a first insight into the addition of Feelee to treatment as usual in the forensic outpatient setting. Study strengths include the low-threshold addition, ecological validity, and the use of both quantitative and qualitative research methods. Further implications for clinical practice are discussed. Trial Registration: Central Committee on Research Involving Human Subjects NL-OMON54390; https://onderzoekmetmensen.nl/en/trial/54390 and ClinicalTrials.gov NCT06509360; https://clinicaltrials.gov/study/NCT06509360 International Registered Report Identifier (IRRID): DERR1-10.2196/64756

Street Temptations is a virtual reality-enhanced training program developed as an add-on intervention for adolescents with disruptive behavior problems. Using mentalization as a primary treatment mechanism, the program aims to address cognitive distortions and increase motivation for behavior change. This study provides an initial evaluation of Street Temptations in a forensic youth care setting, utilizing both quantitative and qualitative data within an A-B-A’ single-case experimental design. Throughout a baseline, intervention, and follow-up phase, adolescents completed daily measurements on cognitive distortions and motivation for behavior change. Secondary outcomes were assessed before baseline, after intervention, and after follow-up, which included mentalization and perspective-taking. Qualitative data were collected after the intervention through separate interviews with adolescents and Street Temptations therapists. A total of 8 adolescents were included in the study, 5 of whom dropped out, leaving 3 who provided sufficient data for visual inspection of the outcomes. The observed patterns suggested an increase in adolescents’ awareness of others’ perspectives during participation in Street Temptations, potentially indicating a positive effect on cognitive distortions. However, daily assessments did not show an increase in adolescents’ motivation for behavior change. Positive effects of Street Temptations and virtual reality, as well as areas for improvement, were highlighted in all interviews. Recommendations for further development and implementation are discussed. Overall, this study provides preliminary support for the use of Street Temptations as an add-on intervention in forensic youth care.

Background: Delinquent behavior in adolescence is a prevalent issue, often associated with difficulties across multiple life domains, which in turn perpetuates negative life outcomes. While current treatment programs show partial success in improving behavioral changes and reducing recidivism, comprehensive conclusions regarding the overall efficacy of these interventions have yet to be established. In forensic outpatient settings, the discrepancy between adolescents’ limited emotional awareness and the predominant emphasis on cognitive reflection, combined with low treatment adherence, may be factors that undermine treatment efficacy. New technologies, such as smartphone apps, may offer a solution by integrating real-life data into treatment to improve emotional and behavioral patterns. The low-threshold use of smartphone data can be useful in addressing these treatment challenges. Objective: This study aimed to explore the feasibility and usability of Feelee (Garage2020), a smartphone app that integrates active emoji and passive behavioral data, as a potential addition to treatment for adolescents in a forensic outpatient setting. Methods: We conducted a prepilot study with adolescents (n=4) who used the Feelee app over a 2-week period. App usage included completing a brief emoji survey 3 times a day (active data) and allowing Feelee to track the call logs, Bluetooth devices in proximity, cell tower IDs, app usage, and phone status (passive data). During treatment sessions, both adolescents and clinicians reviewed and discussed the active and passive data. Semistructured interviews were conducted with adolescents and clinicians (n=7) to gather experiences and feedback on the feasibility and usability of incorporating smartphone data into treatment. Results: The study showed that adolescents (n=3) succeeded in using Feelee for the full 2 weeks, and data were available for discussion in at least 1 session per participant. Both adolescents and clinicians (n=7) stated that Feelee was valuable for viewing, discussing, and gaining insight into their emotions, which facilitated targeted actions based on the Feelee data. However, neither adolescents nor clinicians reported increased engagement in treatment as a result of using Feelee. Despite technical issues, overall feedback on the Feelee app, in addition to treatment, was positive (n=7). However, further improvements are needed to address the high battery consumption and the inaccuracies in the accelerometer. Conclusions: This qualitative study provides an in-depth understanding of the potential benefits of integrating active and passive smartphone data for adolescents in a forensic outpatient setting. Feelee appears to contribute to a better understanding of emotions and behaviors, suggesting its potential value in enhancing emotional awareness in treatment. Further research is needed to assess Feelee’s clinical effectiveness and explore how it enhances emotional awareness. Recommendations from adolescents and clinicians emphasize the need for prepilot studies to address user issues, guiding technical improvements and future research in forensic outpatient settings.

Background and Objectives: Traumatic brain injury (TBI) is the leading cause of acquired disability in children. Children with TBI are at risk of persistent deficits in neurocognitive functioning that affect daily life. However, neurocognitive outcomes are highly heterogenous and this heterogeneity is poorly understood. This study aims to investigate whether the heterogeneity in neurocognitive outcome can be reduced by distinguishing subgroups of children with distinct profiles of neurocognitive functioning, and to investigate whether these subgroups differ in demographic, premorbid and clinical characteristics. Methods: This multicenter study included a consecutive cohort of children with mild to severe TBI and demographically matched neurologically healthy (NH) children. Seven neurocognitive domains were assessed six months post-TBI using computerized tests. The TBI and NH group were compared on the neurocognitive domains using t-tests. Results of the TBI group were subjected to cluster analysis to derive subgroups with distinct profiles of neurocognitive functioning. Resulting subgroups were compared on demographic, premorbid and clinical characteristics available at time of hospital visit. Results: A total of 113 children with TBI and 113 NH children were included. The TBI group had lower performance than NH children on the neurocognitive domains Speed, Stability, Attention & Control, Verbal Working Memory and Visual Working Memory (.009≤ p s≤.047, -.42≤ d s≤-.29). Cluster analysis revealed four subgroups of patients with diverging neurocognitive outcome profiles. One subgroup was characterized by good outcome, whereas three subgroups had adverse outcome characterized by weak global outcome, weak visual-processing outcome or weak executive functioning outcome. The subgroups did not differ in clinical characteristics but did differ in demographic and premorbid characteristics. The weak global outcome subgroup had more premorbid behavioral problems, while the good outcome subgroup had higher socio-economic status than the other subgroups. Discussion: This study indicates that children with mild to severe TBI exhibit neurocognitive deficits compared to matched controls at six months post TBI, among which subgroups of children with distinct neurocognitive outcome profiles exist. The neurocognitive outcome subgroups represent children with diverging severity and configuration of neurocognitive weaknesses. The subgroups with the diverging neurocognitive outcome profiles did not differ in clinical characteristics, highlighting the importance to consider other factors for the prognosis of neurocognitive outcome.