Emotional competence self-help mobile phone app versus cognitive behavioural self-help app versus self-monitoring app to promote mental wellbeing in healthy young adults (ECoWeB PROMOTE): an international, multicentre, parallel, open-label, randomised controlled trial.

BACKGROUND: Based on evidence that mental health is more than an absence of mental disorders, there have been calls to find ways to promote flourishing at a population level, especially in young people, which requires effective and scalable interventions. Despite their potential for scalability, few mental wellbeing apps have been rigorously tested in high-powered trials, derived from models of healthy emotional functioning, or tailored to individual profiles. We aimed to test a personalised emotional competence self-help app versus a cognitive behavioural therapy (CBT) self-help app versus a self-monitoring app to promote mental wellbeing in healthy young people. METHODS: This international, multicentre, parallel, open-label, randomised controlled trial within a cohort multiple randomised trial (including a parallel trial of depression prevention) was done at four university trial sites in four countries (the UK, Germany, Spain, and Belgium). Participants were recruited from schools and universities and via social media from the four respective countries. Eligible participants were aged 16-22 years with well adjusted emotional competence profiles and no current or past diagnosis of major depression. Participants were randomised (1:1:1) to usual practice plus either the emotional competence app, the CBT app or the self-monitoring app, by an independent computerised system, minimised by country, age, and self-reported gender, and followed up for 12 months post-randomisation. The primary outcome was mental wellbeing (indexed by the Warwick-Edinburgh Mental Well Being Scale [WEMWBS]) at 3-month follow-up, analysed in participants who completed the 3-month follow-up assessment. Outcome assessors were masked to group allocation. The study is registered with ClinicalTrials.gov, NCT04148508, and is closed. FINDINGS: Between Oct 15, 2020, and Aug 3, 2021, 2532 participants were enrolled, and 847 were randomly assigned to the emotional competence app, 841 to the CBT app, and 844 to the self-monitoring app. Mean age was 19·2 years (SD 1·8). Of 2532 participants self-reporting gender, 1896 (74·9%) were female, 613 (24·2%) were male, 16 (0·6%) were neither, and seven (0·3%) were both. 425 participants in the emotional competence app group, 443 in the CT app group, and 447 in the self-monitoring app group completed the follow-up assessment at 3 months. There was no difference in mental wellbeing between the groups at 3 months (global p=0·47). The emotional competence app did not differ from the CBT app (mean difference in WEMWBS -0·21 [95% CI -1·08 to 0·66]) or the self-monitoring app (0·32 [-0·54 to 1·19]) and the CBT app did not differ from the self-monitoring app (0·53 [-0·33 to 1·39]). 14 of 1315 participants were admitted to or treated in hospital (or both) for mental health-related reasons, which were considered unrelated to the interventions (five participants in the emotional competence app group, eight in the CBT app group, and one in the self-monitoring app group). No deaths occurred. INTERPRETATION: The emotional competence app and the CBT app provided limited benefit in promoting mental wellbeing in healthy young people. This finding might reflect the low intensity of these interventions and the difficulty improving mental wellbeing via universal digital interventions implemented in low-risk populations. FUNDING: European Commission.

Emotional competence self-help app versus cognitive behavioural self-help app versus self-monitoring app to prevent depression in young adults with elevated risk (ECoWeB PREVENT): an international, multicentre, parallel, open-label, randomised controlled trial.

BACKGROUND: Effective, scalable interventions are needed to prevent poor mental health in young people. Although mental health apps can provide scalable prevention, few have been rigorously tested in high-powered trials built on models of healthy emotional functioning or tailored to individual profiles. We aimed to test a personalised emotional competence app versus a cognitive behavioural therapy (CBT) self-help app versus a self-monitoring app to prevent an increase in depression symptoms in young people. METHODS: This multicentre, parallel, open-label, randomised controlled trial, within a cohort multiple randomised trial (including a parallel trial of wellbeing promotion) was done at four university trial sites in the UK, Germany, Spain, and Belgium. Participants were recruited from schools, universities, and social media from the four respective countries. Eligible participants were aged 16-22 years with increased vulnerability indexed by baseline emotional competence profile, without current or past diagnosis of major depression. Participants were randomly assigned (1:1:1) to usual practice plus either the personalised emotional competence self-help app, the generic CBT self-help app, or the self-monitoring app by an independent computerised system, minimised by country, age, and self-reported gender, and followed up for 12 months post-randomisation. Outcome assessors were masked to group allocation. The primary outcome was depression symptoms (according to Patient Health Questionnaire-9 [PHQ-9]) at 3-month follow-up, analysed in participants who completed the 3-month follow-up assessment. The study is registered with ClinicalTrials.gov, NCT04148508, and is closed. FINDINGS: Between Oct 15, 2020, and Aug 3, 2021, 1262 participants were enrolled, including 417 to the emotional competence app, 423 to the CBT app, and 422 to the self-monitoring app. Mean age was 18·8 years (SD 2·0). Of 1262 participants self-reporting gender, 984 (78·0%) were female, 253 (20·0%) were male, 15 (1·2%) were neither, and ten (0·8%) were both. 178 participants in the emotional competence app group, 191 in the CBT app group, and 199 in the self-monitoring app group completed the follow-up assessment at 3 months. At 3 months, depression symptoms were lower with the CBT app than the self-monitoring app (mean difference in PHQ-9 -1·18 [95% CI -2·01 to -0·34]; p=0·006), but depression symptoms did not differ between the emotional competence app and the CBT app (0·63 [-0·22 to 1·49]; p=0·15) or the self-monitoring app and emotional competence app (-0·54 [-1·39 to 0·31]; p=0·21). 31 of the 541 participants who completed any of the follow-up assessments received treatment in hospital or were admitted to hospital for mental health-related reasons considered unrelated to interventions (eight in the emotional competence app group, 15 in the CBT app group, and eight in the self-monitoring app group). No deaths occurred. INTERPRETATION: The CBT app delayed increases in depression symptoms in at-risk young people relative to the self-monitoring app, although this benefit faded by 12 months. Against hypotheses, the emotional competence app was not more effective at reducing depression symptoms than the self-monitoring app. CBT self-help apps might be valuable public mental health interventions for young people given their scalability, non-consumable nature, and affordability. FUNDING: European Commission.

Displaying pride: Variation by social context, ethnic heritage, and gender?

Pride is universal; however, the complexities linked to its social status functions and implications for social relationships suggest the possibility of variation in its display. Drawing from empirical evidence, this study examined whether displayed pride would vary by social context (i.e., whether the target was a competitor or a loved one), ethnic heritage (i.e., membership in individualistic or collectivistic cultural groups) and by gender. Young adults (N = 145) verbally described a pride experience to an imagined competitor, loved one, stranger or in a no-context control condition. Results showed similarity in displayed pride across the four contexts. However, some ethnic group and gender variations were observed. Latino/a/x Americans displayed less pride verbally than European Americans while women displayed more than men. These findings contribute to a better understanding of how people manage the display of pride and suggest that ethnic and gendered motivations for managing pride displays are relevant to a comprehensive understanding of interpersonal emotion regulation.

The Scoring Challenge of Emotional Intelligence Ability Tests: A Confirmatory Factor Analysis Approach to Model Substantive and Method Effects Using Raw Item Scores.

The internal structure of ability emotional intelligence (EI) tests at item level has been hardly studied, and if studied often the predicted structure did not show. In the present study, an a priori model for responses to EI ability items using Likert response scales with a Situational Judgement Test (SJT) format is investigated with confirmatory factor analysis. The model consists of (1) a target EI ability factor, (2) an acquiescence factor, which is a method factor induced by the Likert response scales, and (3) design-based error covariances, which are induced by the SJT format. It is investigated whether this a priori model can account for the observed associations between the raw item responses of the Components of Emotion Understanding Test-24 (CEUT-24). The CEUT-24 is a new test developed to assess emotion understanding, a key aspect of the EI ability construct, based on the componential emotion framework. The sample consisted of 1184 participants (15-22 years old) from four European countries (United Kingdom, Belgium, Germany, and Spain) speaking four different languages (English, Dutch, German and Spanish). Findings showed that the a priori model fitted the data well in all four languages. Furthermore, measurement invariance testing gave evidence for a well-fitting configural, metric, and partial scalar invariance model. The conclusion is that within a regular CFA framework using raw observed items responses, method factors (acquiescence response style and scenario induced variance) can be disentangled from the targeted EI ability factor.

Keeping the magic alive: social sharing of positive life experiences sustains happiness.

Social sharing of positive life experiences has been linked to increased intensity of positive emotion. Less is known about the relations among sharing, the perceived response of the listener, and the duration of positive emotion. We hypothesised that sharing an experience would sustain positive emotion when listeners responded in a manner that highlighted the appraised importance and remarkability of the experience, thereby slowing hedonic adaptation. College students who received a desirable exam grade (N = 165) reported their emotional response, appraisals, and sharing on the day they received their grade and again the following evening. Sharing was associated with longer episodes of positive emotion and more time spent thinking about the positive event. The association between sharing and emotion duration was greatest when sharing partners were perceived as highlighting the importance and remarkability of the event. This type of sharing also mitigated the fading of emotion intensity over time. These findings suggest that sharing sustains positive emotion by promoting appraisals that "keep the magic alive."

Children's Nonverbal Displays of Winning and Losing: Effects of Social and Cultural Contexts on Smiles.

We examined the effects of social and cultural contexts on smiles displayed by children during gameplay. Eight-year-old Dutch and Chinese children either played a game alone or teamed up to play in pairs. Activation and intensity of facial muscles corresponding to Action Unit (AU) 6 and AU 12 were coded according to Facial Action Coding System. Co-occurrence of activation of AU 6 and AU 12, suggesting the presence of a Duchenne smile, was more frequent among children who teamed up than among children who played alone. Analyses of the intensity of smiles revealed an interaction between social and cultural contexts. Whereas smiles, both Duchenne and non-Duchenne, displayed by Chinese children who teamed up were more intense than those displayed by Chinese children who played alone, the effect of sociality on smile intensity was not observed for Dutch children. These findings suggest that the production of smiles by children in a competitive context is susceptible to both social and cultural factors.

Reappraisal mitigates overestimation of remembered pain in anxious individuals.

Anxiety sensitivity, a trait characterised by fear of anxiety-related body sensations, has been linked to heightened attention to pain, appraising body sensations as threatening, and remembering threat-related information. We assessed whether individuals with greater anxiety sensitivity overestimate in remembering pain. We also assessed whether emotion regulation strategies that direct attention away from pain (distraction), or alter appraisals of pain (reappraisal), alleviate memory bias. Participants (N = 137) were randomly assigned to one of two emotion regulation conditions or to a control condition before taking part in a cold pressor task. Greater anxiety sensitivity was associated with overestimation in remembering pain. Engaging in reappraisal mitigated this memory bias but engaging in distraction did not. This is the first study to examine the relations among anxiety sensitivity, emotion regulation and memory for pain. The findings suggest that health-care practitioners can encourage reappraisal to promote more positive memories of procedural pain, particularly in patients high in anxiety sensitivity.

Conservatives report, but liberals display, greater happiness.

Research suggesting that political conservatives are happier than political liberals has relied exclusively on self-report measures of subjective well-being. We show that this finding is fully mediated by conservatives' self-enhancing style of self-report (study 1; N = 1433) and then describe three studies drawing from "big data" sources to assess liberal-conservative differences in happiness-related behavior (studies 2 to 4; N = 4936). Relative to conservatives, liberals more frequently used positive emotional language in their speech and smiled more intensely and genuinely in photographs. Our results were consistent across large samples of online survey takers, U.S. politicians, Twitter users, and LinkedIn users. Our findings illustrate the nuanced relationship between political ideology, self-enhancement, and happiness and illuminate the contradictory ways that happiness differences can manifest across behavior and self-reports.