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Background Psychopathology research is changing focus from group-based “disease models” to a personalized approach inspired by complex systems theories. This approach, which has already produced novel and valuable insights into the complex nature of psychopathology, often relies on repeated self-ratings of individual patients. So far, it has been unknown whether such self-ratings, the presumed observables of the individual patient as a complex system, actually display complex dynamics. We examine this basic assumption of a complex systems approach to psychopathology by testing repeated self-ratings for three markers of complexity: memory , the presence of (time-varying) short- and long-range temporal correlations; regime shifts , transitions between different dynamic regimes; and sensitive dependence on initial conditions , also known as the “butterfly effect,” the divergence of initially similar trajectories. Methods We analyzed repeated self-ratings (1476 time points) from a single patient for the three markers of complexity using Bartels rank test, (partial) autocorrelation functions, time-varying autoregression, a non-stationarity test, change point analysis, and the Sugihara-May algorithm. Results Self-ratings concerning psychological states (e.g., the item “I feel down”) exhibited all complexity markers: time-varying short- and long-term memory, multiple regime shifts, and sensitive dependence on initial conditions. Unexpectedly, self-ratings concerning physical sensations (e.g., the item “I am hungry”) exhibited less complex dynamics and their behavior was more similar to random variables. Conclusions Psychological self-ratings display complex dynamics. The presence of complexity in repeated self-ratings means that we have to acknowledge that (1) repeated self-ratings yield a complex pattern of data and not a set of (nearly) independent data points, (2) humans are “moving targets” whose self-ratings display non-stationary change processes including regime shifts, and (3) long-term prediction of individual trajectories may be fundamentally impossible. These findings point to a limitation of popular statistical time series models whose assumptions are violated by the presence of these complexity markers. We conclude that a complex systems approach to mental health should appreciate complexity as a fundamental aspect of psychopathology research by adopting the models and methods of complexity science. Promising first steps in this direction, such as research on real-time process monitoring, short-term prediction, and just-in-time interventions, are discussed.

Background The past few years have seen a rapid growth in research on early warning signals (EWSs) in the psychopathology domain. Whereas early studies found EWSs to be associated with sudden changes in clinical change trajectories, later findings showed that EWSs may not be general across variables and cases and have low predictive power. These mixed results may be explained by the diverse methods employed in clinical EWS studies, with some of these approaches and practices potentially misaligned with the underlying theory of EWSs. Methods This article employs a variety of methods, such as a narrative review, mathematical derivations, simulations, and visual illustrations, to support our claims, explain specific assumptions, and guide future empirical research. This multitude of methods serves our aim to provide theoretical as well as methodological contributions to the field. Results We identify the following key assumptions for EWS validation studies: the system departs from a point attractor, EWSs appear before the critical transition, and EWS variables align with system destabilization. The literature review shows that the common research practices in the field are often not in line with those assumptions, and we provide specific suggestions corresponding to each of the assumptions. Conclusions More rigorous empirical evidence is needed to better validate the existence of EWSs in clinical sudden changes and fully realize their clinical potential. As theory-based prediction tools, EWSs require stronger alignment between theory and practice to enhance both theoretical understanding and predictive accuracy. Clinical trial number Not applicable.

Over the course of adolescence, an increasing number of adolescents experience depression. In order to effectively target depression, identifying risk factors for depressive symptoms is pivotal. Since low levels of self-efficacy were associated with higher levels of depressive symptoms in previous studies, the current study investigated the bidirectional and prospective associations between depressive symptoms and academic, social and emotional self-efficacy from early to mid adolescence in a cross-lagged path model. The sample consisted of 1,341 adolescents (47 % girls) with a mean age of 14 years, SD = 0.56. Depressive symptoms and self-efficacy levels were assessed every 6 months over a period of 2.5 years. Depressive symptoms predicted subsequent levels of academic and emotional self-efficacy on all time points, and social self-efficacy on one time point. Self-efficacy did not predict subsequent levels of depressive symptoms. There was no evidence of sex differences in the cross-lagged associations between depressive symptoms and self-efficacy levels. Implications of the findings are discussed.

Concerns regarding smartphones’ and social media’s impact on youth remain high amidst a growing realization that current research is not designed to confirm (or refute) such concerns. This study aims to answer fundamental questions regarding youths’ use of smartphones, by implementing a novel user-centric research method. The smartphone use of 114 emerging adults was recorded, followed by in-depth interviews that incorporated the recording and in-app information to help participants recall their behaviours, motivations, and feelings. Results indicate that smartphone use is indeed ubiquitous; 88 out of 114 participants started using their smartphone as soon as they were left alone. However, the findings of this study also demonstrate great diversity in smartphone use, in e.g. social media platforms used and motivations for using different apps. These results illustrate that it no longer seems sensible to refer to “screen time” as if it represents a homogeneous phenomenon across youth. Additionally, preliminary indications have been found of relationships between individual differences in mental health indices and variations in smartphone use. The current study provides new insights into youths’ smartphone use and its relationship with wellbeing.

Anxiety disorders are the most prevalent mental health problems in childhood. Engaging, adequate, and appropriate prevention programs are needed. Applied games form a potential alternative delivery model and recent evidence suggests that they could be effective. The present randomized controlled non-inferiority trial investigated the beneficial effects of the applied game MindLight compared to cognitive behavioral therapy (CBT) on mental health outcomes associated with anxiety symptoms: internalizing problems, externalizing problems, and self-efficacy. In addition, we examined who benefitted most from both programs and analyzed baseline levels of anxiety, maternal mental health problems, and self-efficacy as predictors of changes in anxiety symptoms. After being screened for elevated anxiety, 174 selected children (8–12-year-old) were randomized to play MindLight or to receive a prevention program based on CBT. Study variables were assessed before and after the intervention, and at 3- and 6-months follow-up. Intention-to-treat analyses showed a significant reduction in mother-reported internalizing and externalizing problems and an increase in self-efficacy. Importantly, the magnitude of change did not differ between intervention groups. Non-inferiority analyses showed that MindLight was as effective as CBT in affecting internalizing problems and self-efficacy. However, CBT was more effective in decreasing externalizing symptoms than MindLight. Furthermore, baseline anxiety levels, maternal mental health problems, and self-efficacy did not influence the change of anxiety symptoms over time. Applied games, specifically theory-based games such as MindLight, hold potential as effective interventions for not only targeting anxiety symptoms, but also more general mental health outcomes.HighlightsApplied games form an alternative delivery model of therapeutic techniques.The applied game MindLight was as effective as CBT in improving youth mental health.In both groups, internalizing and externalizing problems and self-efficacy improved.Differences in baseline mental health were unrelated to intervention outcomes.

Background Challenging behaviors like aggression and self-injury are dangerous for clients and staff in residential care. These behaviors are not well understood and therefore often labeled as “complex”. Yet it remains vague what this supposed complexity entails at the individual level. This case-study used a three-step mixed-methods analytical strategy, inspired by complex systems theory. First, we construed a holistic summary of relevant factors in her daily life. Second, we described her challenging behavioral trajectory by identifying stable phases. Third, instability and extraordinary events in her environment were evaluated as potential change-inducing mechanisms between different phases. Case presentation A woman, living at a residential facility, diagnosed with mild intellectual disability and borderline personality disorder, who shows a chronic pattern of aggressive and self-injurious incidents. She used ecological momentary assessments to self-rate challenging behaviors daily for 560 days. Conclusions A qualitative summary of caretaker records revealed many internal and environmental factors relevant to her daily life. Her clinician narrowed these down to 11 staff hypothesized risk- and protective factors, such as reliving trauma, experiencing pain, receiving medical care or compliments. Coercive measures increased the chance of challenging behavior the day after and psychological therapy sessions decreased the chance of self-injury the day after. The majority of contemporaneous and lagged associations between these 11 factors and self-reported challenging behaviors were non-significant, indicating that challenging behaviors are not governed by mono-causal if-then relations, speaking to its complex nature. Despite this complexity there were patterns in the temporal ordering of incidents. Aggression and self-injury occurred on respectively 13% and 50% of the 560 days. On this timeline 11 distinct stable phases were identified that alternated between four unique states: high levels of aggression and self-injury, average aggression and self-injury, low aggression and self-injury, and low aggression with high self-injury. Eight out of ten transitions between phases were triggered by extraordinary events in her environment, or preceded by increased fluctuations in her self-ratings, or a combination of these two. Desirable patterns emerged more often and were less easily malleable, indicating that when she experiences bad times, keeping in mind that better times lie ahead is hopeful and realistic.

Effectiveness research on depression prevention usually compares pre- to post-intervention outcomes across groups, but this aggregation across individuals may mask heterogeneity in symptom change trajectories. Hence, this study aimed to identify subgroups of adolescents with unique trajectories of change in a school-based depression prevention trial. It was also examined how trajectory membership was associated with the intervention conditions, depressive symptoms at 12-month follow-up, and baseline predictors. Hundred-ninety adolescent girls (Mage = 13.34; range = 11–16 years) with subclinical depression at screening (M = 57 days before pre-test) were allocated to four conditions: a face-to-face, group-based program (OVK), a computerized, individual program (SPARX), OVK and SPARX combined, and a monitoring control condition. Growth Mixture Modeling was used to identify the distinct trajectories during the intervention period using weekly depressive symptom assessments from pre-test to post-test. Analyses revealed three trajectories of change in the full sample: Moderate-Declining (62.1% of the sample), High-Persistent (31.1%), and Deteriorating-Declining (6.8%) trajectories. Trajectories were unrelated to the intervention conditions and the High-Persistent trajectory had worse outcomes at follow-up. Several baseline factors (depression severity, age, acceptance, rumination, catastrophizing, and self-efficacy) enabled discrimination between trajectories. It is concluded that information about likely trajectory membership may enable (school) clinicians to predict an individual’s intervention response and timely adjust and tailor intervention strategies as needed.

This study examines the stressor-response process in physical activity among 226 participants across four countries. We analyzed their step count collected via activity monitors before and after a significant stressor: the COVID-19 lockdown. Results showed that a ‘local dynamic complexity’ metric significantly predicts the rate of recovery to pre-COVID levels of physical activity. These findings provide new opportunities for just-in-time interventions to support physical activity recovery after disruptive stressors.

Numerous studies have shown that people adjust their intake directly to that of their eating companions; they eat more when others eat more, and less when others inhibit intake. A potential explanation for this modeling effect is that both eating companions' food intake becomes synchronized through processes of behavioral mimicry. No study, however, has tested whether behavioral mimicry can partially account for this modeling effect. To capture behavioral mimicry, real-time observations of dyads of young females having an evening meal were conducted. It was assessed whether mimicry depended on the time of the interaction and on the person who took the bite. A total of 70 young female dyads took part in the study, from which the total number of bites (N = 3,888) was used as unit of analyses. For each dyad, the total number of bites and the exact time at which each person took a bite were coded. Behavioral mimicry was operationalized as a bite taken within a fixed 5-second interval after the other person had taken a bite, whereas non-mimicked bites were defined as bites taken outside the 5-second interval. It was found that both women mimicked each other's eating behavior. They were more likely to take a bite of their meal in congruence with their eating companion rather than eating at their own pace. This behavioral mimicry was found to be more prominent at the beginning than at the end of the interaction. This study suggests that behavioral mimicry may partially account for social modeling of food intake.

A large proportion of children experience subclinical levels of anxiety and cognitive-behavioral therapy (CBT) aimed at preventing anxiety disorders is moderately effective. However, most at-risk children do not seek help or drop out of programs prematurely because of stigma, lack of motivation, and accessibility barriers. Applied games have received increased attention as viable alternatives and have shown promising results, but direct comparisons between applied games and the gold-standard CBT are lacking. Our aim was to investigate whether the applied game MindLight is as effective as CBT (i.e., Coping Cat) within an indicated prevention context. We conducted a randomized controlled non-inferiority trial with a sample of 174 children (7- to 12-year olds) with elevated levels of anxiety, comparing MindLight to CBT. Anxiety was assessed with self- and parent-reports at pre- and post-program, and at 3- and 6-month follow-ups. Intention-to-treat and completers-only confidence interval approach and latent growth curve modeling showed an overall significant quadratic decrease in child- and parent-reported anxiety symptoms over time and, as predicted, the magnitude of improvement was the same for MindLight and CBT. The within-group effect sizes were small to medium at post-test (− 0.32 to − 0.63), and medium to large (− 0.60 to − 1.07) at 3- and 6-month follow-ups. Furthermore, MindLight and CBT were rated equally anxiety inducing, difficult, and appealing; CBT was rated as more relevant to daily life than MindLight. The current study adds to the growing research on applied games for mental health and shows that these games hold potential as alternative delivery models for evidence-based therapeutic techniques.