Carolin Steuwe

Background Monitoring own emotions, thoughts and behaviors is an important part of many therapeutic approaches targeting Borderline Personality Disorder (BPD), including Dialectical Behavior Therapy (DBT). Digital technologies can make this self-monitoring process more accessible and lead to higher-quality self-observational data. However, this has not been tested in residential treatment settings.Objective This study assessed determinants of usage and uptake, as well as positive and negative effects of a digital tool for self-monitoring (minime®) on treatment outcomes and procedures. Testing took place on a residential ward providing DBT for patients with BPD.Methods An intervention-group (face-to-face DBT + minime®; n=17) was compared to a control-group (face-to-face DBT + paper Diary-Card; n=9) in a quasi-experimental repeated-measures design (admission, discharge, three-month follow-up). Patients provided questionnaire data on symptoms and software usability, contributed usage data and participated in semi-structured qualitative interviews. The treating clinicians (nurses and psychologists) (n=11) provided questionnaire data on usability and participated in interviews.Results Software usability was rated good (patients) to very good (clinicians) and uptake by patients was good. Patients reported a substantial impact of social influence and guidance on their usage behavior. For clinicians, the balance between added values and added workload was more important. Treatment outcomes were not significantly different between groups, but procedural benefits were identified from qualitative interviews.Conclusions Our results fall in line with studies applying digital self-monitoring to outpatient DBT. They expand previous findings to the residential application of DBT and add important insights into implementation determinants in this setting.

Anxiety disorders are highly prevalent, driving the development of digital mental health technologies and raising important socio-anthropological questions. This study examines the representations and practices surrounding these tools among individuals experiencing anxiety, carers, and healthcare professionals across six European countries. Drawing on qualitative analysis of 100 focus group participants, this study explores lived experiences and perspectives on integrating digital technologies into mental health care. Participants valued the potential of digital tools to foster social connexion, reduce isolation, and empower users, viewing them as complementary to, rather than a substitute for, human interaction due to their limitations in addressing complex needs. Concerns about data security, intrusiveness, and the risk of dehumanising care were also prominent. Cross-country differences highlighted how healthcare policies, socioeconomic conditions, and cultural norms shape attitudes and usage patterns. Individuals experiencing anxiety expressed optimism, while professionals adopted a more cautious stance, emphasising personalisation and ethical oversight. These findings highlight the importance of designing digital mental health tools that are inclusive, equitable, and sensitive to users’ material conditions and needs. This study contributes to sociological debates on health digitalisation, by demonstrating how such technologies can both mitigate and reinforce existing inequalities.

Background: In the face of an increasing treatment need among people with dementia, effective and efficient interventions with a focus on quality of life need to be established. In this context, serious games have received increasing attention. However, there is a lack of apps specifically designed for people with dementia. Objective: In this prospective pilot study, we examined the usability of a newly developed serious game app (“Digimenz”). Methods: A total of 43 people with cognitive impairment and mild to severe dementia completed the repeated-measures study procedure. Participants were recruited from an inpatient geriatric psychiatric ward and a long-term care facility. Participants were asked to complete 4 conditions in randomized order, including playing 3 different serious games (experimental conditions) and reading a newspaper (control condition). Each condition was completed once, and the total duration was 60 to 90 minutes per participant. Data on app usability were collected through self-ratings and observation after each condition. We tested for differences in usability among the conditions and the recruitment sites, and analyzed the relation of usability to cognitive capacity. Results: The serious games were accepted in both settings (long-term care: 30/30, 100% interested; psychiatric ward: 31/41, 76% interested), although study completion was lower in the psychiatric subsample (15/41, 37%) than in the long-term care subsample (28/30, 93%). Global usability was rated good (System Usability Scale global mean score: 79). More severely impaired patients had more pronounced difficulties in learning how to play the games (ρ _{MMSE, Learnability} =−0.61, 95% CI −0.78 to −0.36; P <.001) and playing them alone (ρ _{MMSE, Support} =−0.49, 95% CI −0.69 to −0.19; P <.001). Nevertheless, playing the games was associated with a more positive mood (likelihood ratio χ ² ₃ = 25.09; P <.001), independent of the level of cognitive functioning (likelihood ratio χ ² ₁ = 0.64; P =.42). All games were played with a moderate error rate (0.19‐0.49). Conclusions: Our results indicated a positive association between serious game usage and well-being in patients with dementia, given adequate support. This is a valuable addition to the understanding of serious game usage in dementia care. Although challenging, user-centered development of serious games with people who are severely impaired by dementia is an important research target. Limitations like low data quality and a simplified design are inherent in this study population. Nevertheless, we demonstrated how usability testing in this target group is possible through careful definition and operationalization. The inclusion of different data sources, different recruitment sites, and different levels of cognitive impairment increased the generalizability of the findings. To accommodate severely impaired patients, future developments should incorporate a broader range of difficulties and adaptations to group settings.

Background and Hypothesis: Non-affective psychoses (NAP) are associated with severe consequences with regard to social functioning, physical health, employment, and suicidality. Treatment guidelines recommend cognitive behavioral therapy for psychosis (CBTp) as an effective additional treatment strategy to psychopharmacology. We hypothesized that outpatient CBTp has an add-on effect in individuals with NAP who already receive comprehensive outpatient care (COC) in Germany. Study Design: In a randomized-controlled effectiveness trial, 6 months of COC + CBTp were compared to COC. The primary outcomes were change of symptom severity as assessed by the Positive and Negative Symptom Scale (pre-/post-treatment and 6-month follow-up). Mixed linear models and effect sizes were used to compare changes across treatment groups. Additionally, the number of readmissions was compared. Study Results: N = 130 individuals with chronic NAP were recruited (COC + CBTp: n = 64, COC: n = 66). COC + CBTp participants significantly improved more regarding positive symptom severity (estimated mean difference at follow-up: −2.33, 95% CI: −4.04 to −0.61, P = .0083, d = 0.32) and general psychopathology (estimated mean difference at follow-up: −4.55, 95% CI: −7.30 to −1.81, P = .0013, d = 0.44) than the COC group. In both groups, negative symptom severity did not change significantly over time nor did groups differ regarding readmissions. Conclusion: The results underline an add-on benefit of CBTp in chronically ill individuals with NAP. Superiority of CBTp was demonstrated in comparison with high-quality comprehensive care and may also be true in different comprehensive care settings. Clinical Trials Registration: DRKS00015627.