Translational intervention and prevention

Within the framework of the development of an evidence-based guideline (S2e) on the topic of "Prevention, Diagnosis and Treatment of Anxiety Disorders in Childhood and Adolescence", we are searching worldwide and in international comparison for programs and approaches that have already been tried and tested by studies. In the sense of a meta-analysis, we identify the most promising elements and concepts. Subsequently, we examine whether these results can be used to supplement and thus improve the German S2e guideline, especially with regard to preventive measures.

Aversive emotional tension – unpleasant feelings directed towards oneself – can lead to self-injurious behavior and is associated with disorders of emotion regulation. The young people are unable to deal with their emotions. Can such aversive emotional tension be generated in virtual reality (VR)? In experimental trials, we analyze the possibilities of using VR for diagnosis and therapy, especially for adolescents with emotion regulation disorders and subsyndromal or manifest borderline personality disorder (BPD).

If it were possible to trigger emotional tension with the help of VR in a similar way as in real life, this would expand the therapeutic possibilities enormously: Frustration-ridden situations could be relived and worked on together with the therapist. Likewise, the level of frustration tolerance could be checked virtually and thus the therapeutic success could be classified.

"You and Your Emotions" (DUDE) is a project aimed at young people who self-harm with non-suicidal intent. A prevention program aims to improve emotion control skills. So-called life-skills approaches are pursued using competence strengthening and mental training. Currently, a study is being conducted in 3,200 students in our area to test the prevention program and evaluate its success.

Our special outpatient clinic for risk behavior and self-harm @Risk serves the early detection of subsyndromal BPD in order to protect against a severe course of the disorder and psychosocial consequential damage of a manifest disorder. If there are concrete indications of a risk, those affected receive specialized psychotherapy, the so-called Dialectical Behavior Therapy (DBT) according to Marsha Linehan. This third-wave behavioral therapy, developed specifically for BPD, improves affect regulation through the use of skills: In a first step, triggers for mood swings are perceived and in a second step, behavioral patterns are worked out that help to control emotions.First results show that early detection and treatment is successful not only in the @Risk outpatient clinic but also internationally: An average of only 20 therapy sessions is already sufficient to significantly reduce the presence of criteria for BPD. 

Buerger A, Ernst V, Wolter V, Huss M, Kaess M, Hammerle F
Treating eating disorders in the real world - MaiStep: A skill-based universal prevention for schools.
Prev Med. 2019 June; 123:324-332
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Buerger A, Fischer-Waldschmidt G, Hammerle F, Auer KV, Parzer P, Kaess M
Differential Change of Borderline Personality Disorder Traits During Dialectical Behavior Therapy for Adolescents
J Pers Disord. 2019 Feb; 33(1):119-134. 
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Kolar DR, Hammerle F, Jenetzky E, Huss M, Bürger A
Aversive tension in female adolescents with Anorexia Nervosa: a controlled ecological momentary assessment using smartphones. 
BMC Psychiatry. 2016 Apr; 12; 16:97. doi: 10.1186/s12888-016-0807-8
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