Introduction This presentation will provide an up-to-date cross-national comparison of the individual, environmental and socioeconomic determinants of the European population mental health (MH). Methods The European House & Ambrosetti-funded 2023 Headway Mental Health Index 3.0 initiative collected data on 19 Key Performance Indicators (KPIs) in individual (e.g., smoking), environmental (e.g., air pollution) and socioeconomic (e.g., poor housing conditions) determinants of MH for the European Union 27 countries and the UK. KPIs scores were standardised in a 1-10 Likert Scale (1: worst performance; 10: best performance), thus allowing between-country comparisons of the relative performance. Unadjusted bivariate correlations between KPIs scores were run. Results Finland (8.0), Sweden and Estonia (7.5) had the lowest MH risk, while France (3.1) and Romania (2.8) had the highest MH risk. Smoking (r=-0.43, p=.021), alcohol use (r=0.57, p=.002), daylight hours (r=0.74, p<.001), ecoanxiety (r=-0.51, p=.005), air pollution (r=-0.46, p=.015), commuting time (r=0.42, p=.026) and Fragile State Index (r=-0.44, p=.018) correlated with overall MH status, thus emerging as common determinants of MH across the board. Conclusions The determinants of MH varied across European countries, although the correlation between determinants-based MH risk and MH status was relatively weak, including ‘low-risk, poor MH status’ and ‘high-risk, good MH status’ countries. Further non-tested determinants of MH and/or between-country differences in their responsiveness to the population MH needs may explain this discrepancy. These results may inform future evidence-based public MH policymaking and universal preventive strategies in Europe.

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Opioid use disorder in patients with chronic pain poses a specific clincal challenge. Tapering opioids can initially increase pain, while continuing opioids is associated with tolerance and opioid induced hyperalgesia, resulting in inadequate analgesia. In the long run tapering of opioids or rotation to long-acting alternatives, such as buprenoprphine or methadone, have been associated with less pain and better qualtity of life. In this presentation, evidence for various tapering and rotation strategies will be presented, as well as the possiblities for integrated pain management and addiction care. After this session you will know how to prepare your patient with presciroption opioid use disorder and chronic pain for tapering of opioids, how to support your patient with tapering, including the pace of tapering and the use of supproting pharmacological and non-pharmacoligcal interventions. Finally, it will be discussed who is more likely to benefit from rotation to long-acting opioids, and why some patients might be better of without opioid tapering.

A. Schellekens Grant / Research support from: PI in several studies, funded by national governmental funding agencies.

It is important to address the prevention and early detection of opioid addiction with a comprehensive approach. The collaboration and early attention are essential to mitigate the risks associated with opioid misuse. In this session we will review the myths associated with high risk of opioid addiction and how to address when it has been developed.

Some key strategies could be: Provide accurate and understandable information about the risks associated with opioid use, as well as the early signs of addiction. Consider alternative options for pain management, such as physical therapies, exercise, and medications non-opioids, before prescribing opioids. It is important balance pain relief with control of possible addiction risks. The appropriate and controlled indication of opioids is of vital importance to prevent and detect inappropriate use. Prescribe the lowest dose and duration shortest possible. It is important to visit frequent monitoring to detect signs of misuse and/or addiction.

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In the last decennium there is an explosion of medical devices to help patients in their fight against their psychiatric disorder and if possible to take more control and responsibilities over their own lives. In our research on measurement instruments it was doubted that patients were able to use computers and apps. Happell, 2009, addressed that psychiatric patients were very interested in using apps and also were positive being partners in the development of apps that could enhance their quality of life. Their attitude towards apps in clinical practice was more positive than their clinicians who were afraid of being judged on their performance and are more hesitant (Buwalda, et al., 2015). 10-15 years later millions of patients and clinicians are using applications and other medical devices to enlighten their lives.

But what about the most vulnerable citizens, our patients, in the cities in the context of urbanisation. In Amsterdam the public mental health services developed the self-sufficiency matrix (SSM) to gain insight in the peoples individual possibilities. A measure that insights the adaptation to the complex city life and how they can take care of themselves in this ever changing world. How do they feel about using apps or their professionals in daily clinical practice?

This presentation is about the history of the development of a mental health app for psychiatric patients in the city to be used by the professionals. Through a small pilot the presenter will a show the process of development of the SSM-app that gives insight in the wellbeing of the most vulnerable and their needs. We will also discuss the challenges and user-friendliness of the SSM- app in our PMH to make our work more digital proof.

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Informal caregivers are essential in supporting individuals facing mental health challenges, yet the demanding nature of their role can lead to significant distress and long-term psychological strain. International guidelines consistently highlight the critical importance of early caregiver support and identify psychoeducation for caregivers as one of the most effective interventions to support them. However, psychoeducational programmes for caregivers remain significantly underutilised. To address this pressing gap in mental health support, Rey et al. (2020), in collaboration with Unafam, the French national family association, developed the BREF programme. This innovative psychoeducational intervention is designed to provide early and systematic support for caregivers of people with severe mental disorders.

This study investigated the impact of the BREF programme, focusing on its potential to mitigate depressive symptoms and alleviate the psychological burden experienced by caregivers.

This study used a single-group pre-post design. It included family caregivers who participated in the BREF programme from November 2020 to March 2022. Changes in caregiver depressive symptoms (CES-D) and burden (ZBI) measured pre-, post- and 3 months after intervention. Caregivers’ satisfaction and perceived usefulness were also assessed.

Data from 206 family caregivers were analysed. The depression and burden scores significantly decreased immediately after the intervention (p<0.001) and at the 3-month follow-up (p<0.05). Additionally, 98% of participants reported being satisfied to very satisfied, 95% of them deemed it very to extremely useful.

The BREF programme demonstrated significant benefits, notably reducing caregivers’ depressive symptoms and burden. Designed for early systematic implementation this standardized, time- and resource- efficient intervention, offers à promising foundation for a structured and graduated support pathway for caregivers.

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Postpartum stress and mental disorders have a high prevalence in the population. Postpartum depressed states, for example, potentially threaten care of and bonding with the children. Although mothers face specific needs, specialized treatment options are scarce. Online programs to inform on and treat postpartum stress and depression are, to present, not widely available, but have the potential to overcome some of the obstacles of postpartum women finding treatment.

To identify needs of this specific group, we conducted an online survey on women after childbirth, asking for acceptance of e-health programs, sociodemographic, medical and psychometric data.

In a large, anonymized online survey, 453 women have participated. We investigated 1) the acceptance of tailored e-mental health programs according to the UTAUT model in the respective women and 2) characteristics and needs of the specific populations. Based on our findings, we developed an online tool for stress reduction after child-birth based on relevant topics indicated by and data from the literature on specific needs of post-partum women.

In this talk, motivation for this project, research results and ongoing research will be highlighted and discussed.

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People within LGBTIQ+ are significantly more likely to suffer a mental health disorder and substance use disorder compared to heterosexual persons. Stigma, discrimination, and lack of social support are considered as some of the contributing factors to the higher incidence of psychiatric morbidity in this group. Simultaneously, the group’s rights vary around the world, and example being that for example homosexuality is criminalized in many countries and sometimes punishable by death.

Even in countries where homosexuality and belonging to LGBTIQ+ community is not criminalized or is well accepted in the society; the studies show increased odds of poor mental health in this group. For example, a study conducted in Sweden, where same – sex marriage is legal, comparing suicide risk between heterosexual and same-sex married couples showed that same-sex married men had a was nearly three-fold greater suicide risk in comparison to their heterosexual counterparts. Accessible and evidence – based LGBTIQ+ affirmative psychiatric services are crucial for addressing the mental health care needs of the group. These services can be supported by well-structured and efficient training of mental health care professionals.

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This presentation will serve as an overview of LGBTQ+ Clinical Care in the United States and throughout the world. Using the specific example of the Los Angeles LGBT Center, Dr. Ahuja will discuss the need for an LGBTQ+-specific mental health clinic. The reasons for having specialized care are numerous, but boil down to several significant areas.

First, the LGBTQ+ community suffers from large health disparities. This often results from lack of specialized knowledge by providers and health advocates. An LGBTQ+ specific center allows for experts to exchgange and enhance information, incerased research into this population which results in better standars of care, and a chance to educate others regarding LGBTQ+ care. They can serve as a model for other clinics or any other health settings where practitioners can implement LGBTQ+-specific practices that work for them and their patients and on a scale that makes sense.

Second, there is much evidence of discrimination by healthcare providers and insurance companies regarding the LGBTQ+ community, particularly when it comes to the Transgender population. This can include rude behavior by providers, missed screenings due to not paying attention to patient anatomy or LGBTQ+ status, misgendering, harrasment, and lack of insurance coverage for procedures. An LGBTQ+ center allows for patients to have healthcare advocates who can fight for approval and ensures that patients are not harrassed for being LGBTQ+ which results in many patients forgoing necessary care. Further, screenings and patient education regarding things like Pre-Exposure Prophylaxis and Hormone Therapy are much improved as the center and its providers have the knowledge and mission to carry out large-scale educaton efforts.

Finally, an LGBTQ+ center like the Los Angeles LGBT Center inevitably becomes a community hub. These centers function to not just provide medical care but also to advocate for LGBTQ+ issues, coordinate with other centers to manage population disease outbreaks, fight misinformation and disinformation with accurate research, and provide many ancillary services including housing and social community spaces.

Select Sources

James, S.E., Herman, J.L., Durso, L.E., & Heng-Lehtinen, R. (2024). Early Insights: A Report of the 2022 U.S. Transgender Survey. National Center for Transgender Equality, Washington, DC.

Holt S, Ahuja A (2025). LGBTQ+ Intimate Partner Violence: A Guide for Mental Health Practitioners. Routledge.

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Professionals’ attitudes, cultural background, and previous experiences are relatively stable and organized features of their backgrounds. They can affect the therapeutic process and provision of health care to LGBTIQ+ clients in both directions- affirmative and oppressive. Healthy development of sexual orientation and gender identity and their integration is one obvious prerequisite for healthy psycho-sexual and psychological development. Mental health care professionals should be aware of their attitudes, and cultural background, and how they can influence the therapeutic process with and provision of health care to LGBTIQ+ clients to provide culturally sensitive and LGBTIQ+ affirmative practice.

LGBTIQ+ affirmative health care can include any single or combination of several social, psychological, behavioral, or medical interventions designed to support and affirm an individual’s sexual orientation and/or gender identity.

Stigma-related stressors experienced by LGBTIQ+ people across these levels can take the form of relational trauma, and thus compound general life stressors that represent an additional risk for different stress-related outcomes including poor mental health and health-risk behaviors.

Expectations of rejection might be particularly frequent experiences among transgender and gender-diverse people. Existing data depict LGBTIQ+ populations to be at a greater risk for poor health outcomes and a plethora of risk behaviors.

Transgender and gender diverse (TGD) people most often perceive available healthcare to be of inadequate quality and potentially unsafe. However, up to now healthcare systems across Europe fail to provide equal access for TGD compared to cisgender people It has been estimated that at least 27% of TGD people in Europe fail to access TGD care. Compared to cisgender people and compared to lesbian, gay, bisexual, or intersex people, TGD people are most affected by not having access to appropriate care, and they are among those reporting the highest rates of experiencing bad health.

Access to the highest standard of LGBTIQ+ affirmative health care, including LGBTIQ+ affirmative approach within psychotherapeutic practice, that respects dignity and right of self-determination, personal, physical, and psychological integrity, autonomy, and wellbeing of LGBTIQ+ people, and that relies on evidence-based practice, clinical guidelines and standards of care should be a priority across European health care systems and psychotherapeutic modalities. Education and sensitization of medical, and mental health professionals, psychotherapists, and other health care professionals on sexuality, sexual orientations, gender identities, and diversities should be implemented as core intercultural competencies through the obligatory curriculum courses of health and mental health professionals.

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Medical students are persistently exposed to specific conditions that may have detrimental effects on mental health, such as stressful academic routine, demanding and heterogeneous curriculum, sense of competition and daily exposure to illness and death. Accumulating evidence highlights high levels of cynicism and emotional exhaustion among these subjects. Indeed, the prevalence of burnout syndrome in medical students may reach peaks up to 88% in some studies. Thoughts of stopping medical education, negative life events, lack of support, dissatisfaction, and poor motivation represent the main predictors of burnout in this group. Such findings highlight the need to develop prevention initiatives targeting the future generation of medical doctors. Moreover, implementation of psychosocial interventions delivered from medical schools could be helpful to improve coping strategies and resilience styles of students.

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Ketamine has been established as a rapid and potent antidepressant. However, despite its groundbreaking efficacy, it has several limitations, including the transient nature of its antidepressant effects following a single infusion, as well as the phenomenology of acute intoxication. This state is characterized by altered consciousness, manifesting as dissociative or psychotomimetic phenomena, along with cardiovascular changes, such as fluctuations in systolic and diastolic blood pressure.

The presentation explores whether these phenomena should be regarded as mere side effects or if they might play a role in ketamine’s antidepressant mechanisms. Furthermore, it addresses the ongoing challenge of identifying clinical and phenomenological predictors of a better antidepressant response.

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The recent development of the socalled “psychedelics” reminds us that unfortunately some medications which we used in psychiatry have a large burden of side effects, like the anticholinerg side effects of the older tricyclic antidepressants as well as the extrapyramidal motoric side effects of socalled typical neuroleptics. These side effects were sometimes also related to the efficacy of these medications. Interestingly, it seems that the neglection of side effects is still an unresolved issue in clinical psychopharmacology, since there are researchers and clinicians who argue that the psychedelic experience induced with psychedelics are associated with therapeutic efficacy. Furthermore, studies in this field not even mention these side effects as such and argue, when confronted with the issue, that these are necessary for the therapeutic outcome. Even more so, there are researchers and clinicians who think that these side effects allow the patients to understand their unconscious, like in the early days of psychoanalysis. However, recent preclinical animal models demonstrated antidepressant-like behavioral effects and synaptic actions that are not only linked to the serotonergic activation (mainly via the 5HT2A receptor), but also via opioid and glutamatergic pathways which share neurobiological mechanisms of network reconfiguration likely by intracellular plasticity cascades. It seems to be important from my point of view to develop antidepressant medications devoid of the side effect of psychedelic experience in order to produce a safer, non-hallucinogenic medication that has therapeutic potential for depressed patients.

S. Kasper Consultant of: In the past 3 years Dr Kasper served as a consultant or on advisory boards for Angelini, Biogen, Boehringer, Esai, Janssen, IQVIA, Mylan, Recordati, Rovi, and Schwabe; , Speakers bureau of: In the past 3 years Dr. Kasper served on speakers bureaus for Angelini, Aspen Farmaceutica S.A., Biogen, Janssen, Recordati, Schwabe, Servier, and Sothema.

Infectious diseases are known to significantly increase the risk for later development of a mental disorder. Nonetheless, only few studies utilized big-data strategies to evaluate whether cumulative viral infection increases the risk of a subsequent mental illness, and whether risk and resilience factors a likely to modify theses associations. Methods: This study assessed the likelihood of mental illness development among individuals with recurrent exposure to pre-determined viruses (n = 53,416). The viral blood tests included in the analysis was based on consensus agreement of the VIRAL-MI consortium members, and was based on test validity, mandatory vaccination profiles, and the test’s ability to detect acute infection. Broadly, these tests included positivity to the following viral infections: Cytomegalovirus, Epstein-Barr virus, Hepatitis, Herpes, Toxoplasma and Influenza. Data was obtained through the Clalit Health Services, the largest healthcare organization in Israel. Results: Overall, 663,231 tests were obtained from the cohort of 53,416 cases. Kaplan-Meier analyses indicated that individuals infected with more than three viruses were significantly more likely to develop a mental disorder (Log rank 14.55, p<.001). Of the investigated disorders, only anxiety disorders presented a significantly differential pattern of cumulative risk, in the same direction (Log rank 10.06, p = .007). Conclusions: Cumulative viral infections may have significant contribution to the development of a mental disorder. Limitations and integration with previous research will be discussed.

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Immunoassays such as enzyme-linked immunosorbent assays (ELISAs) provide precise measurements of class-specific antibodies to infectious agents. The application of these assays to blood and cerebrospinal fluid from individuals with psychiatric disorders has supported a role for microbial agents in these conditions. However, standard immunoassays are limited by their capacity to measure antibodies to only a single or a small number of infectious agents and epitopes, restricting the ability to identify differential immune responses.

Recent technological advances now allow for comprehensive profiling of immune responses to multiple infectious agents and their specific antigenic epitopes. These methods enable the investigation of differential immune responses as potential modulators of psychiatric disease risk.

We applied two novel serological platforms to analyze immune responses in blood samples from individuals with various psychiatric disorders and suicidal behaviors, as well as healthy controls. The first method assessed antibodies to >4200 peptides derived from >80 infectious agents immobilized onto a solid-phase surface. These peptides were incubated with small blood volumes, and antibody binding was detected via secondary reactions.

Results demonstrated significant differences in immune responses to Toxoplasma gondii and Epstein-Barr virus (EBV) in individuals with schizophrenia and other severe psychiatric disorders. Responses to T. gondii were primarily directed at dense granule (GRA) proteins, with multiple GRA peptide reactivities detected even in individuals classified as “seronegative” by standard immunoassays. For EBV, differential responses were observed to ZEBRA and other latency-associated proteins. Findings were corroborated using a phage display system, where peptides derived from viral proteins were expressed on the phage surface.

Interestingly, immune reactivity was not uniformly increased or decreased but varied depending on the specific antigen. These findings suggest that psychiatric disorder-associated immune alterations may not merely reflect pathogen exposure but also differences in immune response patterns. Further investigation of these differential responses could inform novel diagnostic, preventive, and therapeutic strategies for severe psychiatric disorders.

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Since their emergence as healthcare practices with scientific backgrounds, psychiatry and psychology have been criticized and attacked in different ways. Their scientific base has often been questioned, but more generally, their applications were suggested to follow alternative motives rather than the highest benefit of the suffering individuals. The antipsychiatry movement, with decades of history, on some occasions, could be considered to play an important role in optimizing psychiatric practices. However, with the increasing societal influence of antiscientific and pseudoscientific discourses, a significant section of individuals with mental health issues experience delays in their access to appropriate care and are sometimes harmed by the practices recommended as alternatives to psychiatry or medicine in general. There has been an increase in such misleading discourses following the pandemic, probably based on the uncertainty and lack of information on the nature of the infection and prevention methods, including the vaccine. In some instances, these misleading attitudes toward psychiatry and psychiatric practices are also pioneered by medical professionals. Some medical professionals deny the need and effectiveness of psychiatric practices, and some employ or recommend methods of care despite their lack of training and experience and the questionable nature of the practices. In many countries, national psychiatric associations are considered a leading source of information concerning mental health-related issues. However, without a systematic, need- and problem-focused strategy, including publicly available and acceptable information resources, it is difficult to oppose the overflow of misleading information currently available. Laws and regulations in many countries may act as a barrier against practices with no evidence base or with evidence of harmful effects. However, there are challenges in their implementation and limitations in their scope. National psychiatric associations may need to be involved in creating and implementing such regulations.

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Attitudes toward people with mental illness change. We present evidence of attitude change from different contries, with regard to different mental health conditions. While attitudes towads mental health problems in general, and towards depression, seem to soften, there is little positive change with regard to people with substance use disorders, and attitudes have even worsened towards people with schizophrenia. We discuss possible explanations for these diverging trends, and hypothesize on potential remedies.

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Virtual reality (VR) has the potential to enhance current psychotherapies for psychotic symptoms by simulating virtual environments that evoke responses reflective of real-world scenarios.

This study aimed to evaluate the effectiveness of VR-based psychotherapeutic interventions through findings from two large-scale randomized clinical trials—CHALLENGE and Face Your Fears—that targeted auditory hallucinations (AH) and paranoia, respectively, in individuals with schizophrenia spectrum disorders (SSD).

The CHALLENGE and Face Your Fears trials were randomized, assessor-blinded, parallel-group superiority trials that enrolled 270 and 254 patients with SSD, respectively. In the CHALLENGE trial, participants were randomized to 7 sessions of Challenge-VR therapy (Challenge-VRT) or treatment-as-usual (TAU). In Face Your Fears, participants received either 10 sessions of VR-CBT or standard CBT.

Linear mixed-model analyses on primary and secondary outcomes in both trials revealed that in the CHALLENGE Trial, Challenge-VRT significantly reduced AH symptom severity, as measured by the Psychotic Symptoms Rating Scales (PSYRATS-AH total, adjusted mean difference: -2.26, 95% CI: -4.26 to -0.25, p = 0.03) and frequency (PSYRATS-Frequency, adjusted mean difference: -0.84, 95% CI: -1.53 to -0.14, p = 0.02) at treatment cessation. Face Your Fears Trial: No significant differences were observed between groups on the primary outcome at endpoint (adjusted mean difference: 1.12, 95% CI: -1.75 to 3.99; Cohen’s d = 0.10; p = 0.44). However, both groups demonstrated large within-group improvements (VR-CBT: Cohen’s d = 0.88; standard CBT: Cohen’s d = 0.87). Standard CBT demonstrated superiority over VR-CBT on the secondary outcome measure emotion recognition latency overall at treatment cessation (adjusted mean difference -348.3, 95%CI: -696-6 to -0.04; Cohen’s d = 0.25, p= 0.05), and on emotion recognition accuracy, sadness at 9 months follow-up (adjusted mean difference 0.85, 95% CI: 0.06 to 1.63; Cohen’s d = 0.27, p= 0.03). No serious adverse events were reported in either trial.

Challenge-VRT appears to be a promising treatment for reducing the severity of AH in SSD, though further research is required to optimize and extend its efficacy across broader aspects of schizophrenia. In contrast, VR-CBT did not demonstrate superiority over standard CBT for paranoia, suggesting that both treatments may offer comparable benefits. Future research should explore mediators and moderators of treatment efficacy, as well as patient preferences, to tailor interventions for maximum impact.

L. Birkedal Glenthøj Consultant of: Consultancy for Khora-VR., M. Nordentoft: None Declared

Cognitive behaviour therapy is the main evidence-based psychological treatment for paranoid ideations in patients with psychotic disorders. Virtual reality may improve psychological treatment, because it facilitates behaviour interventions aimed at reducing avoidance and dropping safety behaviours. We investigated the effects of virtual-reality-based cognitive behaviour therapy for paranoid ideations (VR-CBTp) compared to standard CBTp.

We performed a pragmatic single-blind, randomised clinical trial in seven mental health centres in the Netherlands and Belgium. Eligible patients had a psychotic spectrum disorder and experienced paranoid ideations. Both interventions consisted of 16 sessions maximum. Treatment could be completed early when all goals had been achieved. The primary outcome was momentary paranoia, measured with the experience sampling method (ESM). Secondary outcomes included other measures of paranoid ideations, safety behaviour, social anxiety, depression, worry and self-esteem.

103 participants were enrolled and 98 randomised to VR-CBTp (n=48) or CBTp (n=50). At post-treatment, VR-CBTp had significantly stronger effects than standard CBTp at post-treatment on momentary paranoia (interaction effect b=-0·3, 95% CI -8·4 to 7·8, n=81, p=0·04, effect size 0·62), safety behaviour, depressive symptoms and self-esteem, of which the difference in effects on self-esteem and social interaction anxiety remained at follow-up. Completers on average received 12·4 (VR-CBTp) and 15·0 (CBTp) sessions. Limited ESM compliance resulted in 43% data loss at post-treatment and 49% at follow-up.

CBTp and VR-CBTp are both efficacious treatments for paranoid ideations, but VR-CBTp may be somewhat more effective and more efficient than CBTp.

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Delusions are one of the core symptoms of schizophrenia spectrum disorders (SSD). Traditional Cognitive Behavioral Therapy (CBT) approaches are less effective for delusions, require significant resources, and specialized staff training. Symptom-specific therapy approaches, which target factors involved in the development and maintenance of psychotic symptoms, provide a valid alternative. Digital technologies, such as ecological momentary assessment (EMA) and ecological momentary intervention (EMI), are gaining attention in mental health, providing enhanced assessment and intervention opportunities. The present single-arm trial aimed to investigate the feasibility, acceptability, and preliminary outcomes of a smartphone-based blended EMA/I psychological therapy approach - DICE - focusing on improving coping strategies for delusions in SSD. In total, N = 10 participants received four face-to-face therapy sessions alongside German university-level treatment-as-usual over an intervention period of four to six weeks. Feasibility was assessed by completion rates of the EMA/I questionnaires, use of the application between sessions and recruitment rates. Acceptability was assessed by a satisfaction questionnaire, open feedback, and analysis of adverse effects. Clinical outcomes included self-rated and rater-based intensity and distress of delusions and comorbid symptoms at pre- and post-intervention. Findings supported the feasibility and acceptability of the DICE intervention, with high retention (10/13 participants; 77%) and completion rates for the EMA- (59%) and EMI-questionnaires (72%), as well as a high protocol adherence (90-97%), exceeding all predefined benchmarks. Open feedback indicated good satisfaction, with all participants using the application between sessions, reflecting a high engagement level. Clinical outcomes displayed relevant changes in ameliorating the intensity of delusions when being measured by the Psychotic Symptom Rating Scales as well as by the Green Paranoid Thought Scale, and self-rated improvements in distress and depressive symptoms. Changes in the intensity and distress of delusions might be explained by improved coping behaviour. Further research with control conditions is needed to validate findings and analyze the efficacy as well as mechanisms of actions of the DICE intervention in a fully powered trial.

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