{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T10:12:37Z","timestamp":1792836757107,"version":"4.5.0"},"reference-count":75,"publisher":"American Medical Association (AMA)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Psychiatry"],"published-print":{"date-parts":[[2024,3,1]]},"abstract":"\n Importance<\/jats:title>\n Targeting low self-esteem in youth exposed to childhood adversity is a promising strategy for preventing adult mental disorders. Ecological momentary interventions (EMIs) allow for the delivery of youth-friendly, adaptive interventions for improving self-esteem, but robust trial-based evidence is pending.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To examine the efficacy of SELFIE, a novel transdiagnostic, blended EMI for improving self-esteem plus care as usual (CAU) compared with CAU only.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This was a 2-arm, parallel-group, assessor-blinded, randomized clinical trial conducted from December 2018 to December 2022. The study took place at Dutch secondary mental health services and within the general population and included youth (aged 12-26 years) with low self-esteem (Rosenberg Self-Esteem Scale [RSES] &amp;lt;26) exposed to childhood adversity.<\/jats:p>\n <\/jats:sec>\n \n Interventions<\/jats:title>\n A novel blended EMI (3 face-to-face sessions, email contacts, app-based, adaptive EMI) plus CAU or CAU only.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n The primary outcome was RSES self-esteem at postintervention and 6-month follow-up. Secondary outcomes included positive and negative self-esteem, schematic self-beliefs, momentary self-esteem and affect, general psychopathology, quality of life, observer-rated symptoms, and functioning.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n A total of 174 participants (mean [SD] age, 20.7 [3.1] years; 154 female [89%]) were included in the intention-to-treat sample, who were primarily exposed to childhood emotional abuse or neglect, verbal or indirect bullying, and\/or parental conflict. At postintervention, 153 participants (87.9%) and, at follow-up, 140 participants (80.5%), provided primary outcome data. RSES self-esteem was, on average, higher in the experimental condition (blended EMI + CAU) than in the control condition (CAU) across both postintervention and follow-up as a primary outcome (B\u2009=\u20092.32; 95% CI, 1.14-3.50;\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001; Cohen\n d<\/jats:italic>\n -type effect size [hereafter, Cohen\n d<\/jats:italic>\n ] =\u20090.54). Small to moderate effect sizes were observed suggestive of beneficial effects on positive (B\u2009=\u20093.85; 95% CI, 1.83-5.88;\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001; Cohen\n d<\/jats:italic>\n \u2009=\u20090.53) and negative (B\u2009=\u2009\u22123.78; 95% CI, \u22126.59 to \u22120.98;\n P<\/jats:italic>\n \u2009=\u2009.008; Cohen\n d<\/jats:italic>\n \u2009=\u2009\u22120.38) self-esteem, positive (B\u2009=\u20091.58; 95% CI, 0.41-2.75;\n P<\/jats:italic>\n \u2009=\u2009.008; Cohen\n d<\/jats:italic>\n \u2009=\u20090.38) and negative (B\u2009=\u2009\u22121.71; 95% CI, \u22122.93 to \u22120.48;\n P<\/jats:italic>\n \u2009=\u2009.006; Cohen\n d<\/jats:italic>\n \u2009=\u2009\u22120.39) schematic self-beliefs, momentary self-esteem (B\u2009=\u20090.29; 95% CI, 0.01-0.57;\n P<\/jats:italic>\n \u2009=\u2009.04; Cohen\n d<\/jats:italic>\n \u2009=\u20090.24), momentary positive affect (B = 0.23; 95% CI, 0.01-0.45;\n P<\/jats:italic>\n = .04; Cohen\n d<\/jats:italic>\n = 0.20), momentary negative affect (B = \u22120.33; 95% CI, \u22120.59 to \u22120.03,\n P<\/jats:italic>\n = .01, Cohen\n d<\/jats:italic>\n = \u22120.27), general psychopathology (B\u2009=\u2009\u221217.62; 95% CI, \u221233.03 to \u22122.21;\n P<\/jats:italic>\n \u2009=\u2009.03; Cohen\n d<\/jats:italic>\n \u2009=\u2009\u22120.34), and quality of life (B\u2009=\u20091.16; 95% CI, 0.18-2.13;\n P<\/jats:italic>\n \u2009=\u2009.02; Cohen\n d<\/jats:italic>\n \u2009=\u20090.33) across postintervention and follow-up. No beneficial effects on symptoms and functioning were observed.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n A transdiagnostic, blended EMI demonstrated efficacy on the primary outcome of self-esteem and signaled beneficial effects on several secondary outcomes. Further work should focus on implementing this novel EMI in routine public mental health provision.<\/jats:p>\n <\/jats:sec>\n \n Trial Registration<\/jats:title>\n \n Dutch Trial Register Identifier:\n NL7129(NTR7475)<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamapsychiatry.2023.4590","type":"journal-article","created":{"date-parts":[[2023,11,29]],"date-time":"2023-11-29T11:34:39Z","timestamp":1701257679000},"page":"227","source":"Crossref","is-referenced-by-count":30,"title":["Transdiagnostic Ecological Momentary Intervention for Improving Self-Esteem in Youth Exposed to Childhood Adversity"],"prefix":"10.1001","volume":"81","author":[{"given":"Ulrich","family":"Reininghaus","sequence":"first","affiliation":[{"name":"Central Institute of Mental Health, Department of Public Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany"},{"name":"Centre for Epidemiology and Public Health, Institute of Psychiatry, Psychology & Neuroscience, 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