Use of the novel transdiagnostic ecologic momentary intervention EMIcompass may result in reduced stress reactivity and improved quality of life (QOL) among youth with early mental disorders, according to study findings published in Schizophrenia Bulletin.

Many psychotic and severe mental disorders have onset in adolescence and early adulthood.

Researchers conducted a randomized controlled trial (RCT) to evaluate the feasibility and efficacy of an ecologic momentary intervention in improving resilience among youth with early mental health disorders.

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EMIcompass was a 6-week compassion-focused intervention with 4 biweekly sessions of 45 to 60 minutes plus an optional session on-demand. Sessions were administered by video conferencing or face-to-face and included soothing imagery, breathing exercises, and compassionate writing techniques. Intervention training was incorporated into individuals’ daily lives using various delivery methods administered through a smartphone-based app.

Study participants were enrolled from mental health services in Mannheim, Germany, and were randomly assigned 50:50 to experimental condition (EMIcompass plus standard treatment) or control condition.

Eligible participants were aged between 14 and 25 years, experienced a clinical high at-risk mental state (stage 1b), current psychologic distress (stage 1a), or first episode of severe mental disorder (psychotic, bipolar, severe depressive, or severe anxiety disorder; stage 2), based on assessments by structured clinical interview for Diagnostic and Statistical Manual of Mental Disorders (DSM)-5, comprehensive assessment of at-risk mental state, and self-report. Additional inclusion criteria included high-stress reactivity and reduced positive affect score or increased negative affect score.

A total of 92 participants (mean age, 21.67 years; 72.8% adolescent girls; and 78.3% White) met the criteria for the feasibility of trial methodology and intervention delivery, with 52 meeting the criteria for stage 1a, 28 for stage 1b, and 12 for stage 2.

Initial outcome signals for reduced momentary stress reactivity were noted (unstandardized β=-0.10; 95% CI, -0.16 to -0.03; d=-0.10), enhanced momentary resilience (β=0.55; 95% CI, 0.18-0.92; d=0.33), aberrant salience (β=-0.38; 95% CI, -0.57 to -0.18; d=-0.56), and quality of life (β=0.82; 95% CI, 0.10-1.55; d=0.60) across the 4-week follow-up and after the intervention.

Researchers found suggestive evidence of reduced observer-rated symptoms at the 4-week follow-up (β=-1.41; 95% CI, -2.85 to 0.02; d=-0.41) but no outcome signals of efficacy of the EMIcompass intervention for self-reported psychologic distress (β=0.57; 95% CI, -1.59 to 2.72; d=0.09).

Study limitations include the imbalanced number of participants across the 3 clinical stages; limiting the age of participants to 25 years; and the lack of evaluation of EMI components and face-to-face sessions, counseling, support and efficacy as separate investigations.

“Evidence from this exploratory RCT further suggests initial signals that EMIcompass may reduce stress reactivity and enhance both resilience in daily life and quality of life in youth as priority target population,” the researchers concluded. They also noted, “This will provide the basis for addressing the long-recognized but still often neglected research-to-practice gap for this novel EMI at an early stage, with the goal of transfer, uptake, and scale-up of EMIcompass as an evidence-based innovation generated along the translational chain from risk and protective mechanisms to improving population mental health.”

Disclosure: One study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.


Reininghaus U, Paetzold I, Rauschenberg C, et al. Effects of a novel, transdiagnostic ecological momentary intervention for prevention, and early intervention of severe mental disorder in youth (EMIcompass): findings from an exploratory randomized controlled trialSchizophr Bull. Published online February 4, 2023. doi:10.1093/schbul/sbac212

This article originally appeared on Psychiatry Advisor