Improving self-esteem in traumatized youth: a transdiagnostic ecological momentary intervention trial (SELFIE)

The majority of mental disorders first emerge in youth and, as such, contribute substantially to disease burden. Three quarters of adult mental disorders emerge before the age of 25, and 50% before the age of 16. This onset phase disrupts critical age-specific developmental, interpersonal, occupational and educational milestones and indicates a need for close scrutiny of the complex interplay between risk and protective factors in childhood, and the value of a preventive intervention to improve well-being, enhance resilience and prevent morbidity later in life. Evidence has accrued linking childhood trauma as a major risk factor, with a range of mental disorders via pathways through self-esteem. Therefore, targeting low self-esteem in youth exposed to childhood trauma is a promising strategy for preventing adult mental disorder, but our current psychological help strategies remain difficult to access and accept for youth, calling for novel, youth-friendly approaches. The recent rapid advances in information and communication technologies have led to the development of mobile Health (mHealth) and, most prominently, ecological momentary interventions (EMIs), which provide a unique opportunity to deliver youth-friendly, personalized, real-time, guided self-help interventions. The current study aims to minimize the deleterious impact of childhood trauma through testing the efficacy of a novel, accessible, transdiagnostic ecological momentary intervention for improving self-esteem (‘SELFIE’) in help-seeking youth with prior exposure to childhood trauma. In an exploratory randomized controlled trial, youth aged 12-25 with prior exposure to childhood trauma referred to mental health services across the Netherlands (Virenze, Mondriaan, Parnassia, Bascule, or Amsterdam Medical Centre) will be randomly allocated to the SELFIE in addition to treatment as usual (TAU) (experimental condition) or to TAU only (control condition). Data will be collected before randomization (‘baseline’), at the end of the 6-week intervention period (‘post-intervention’), and after a 6-month, 18-month, and 2-year follow-up period (‘follow-up’). Participants allocated to the TAU (control) condition will continue to receive all the treatment they received prior to the start of the study. Subjects allocated to the experimental condition will receive the manualised SELFIE with a trained clinical psychologist within a 6-week period after randomization in addition to TAU. The intervention will consist of three sessions with a trained clinical psychologist, on-demand e-mail contact, and the SELFIE using a guided self-help approach administered through a smartphone-based PsyMate® App to allow for interactive, personalized, real-time and real-world transfer of intervention components in individuals’ daily lives. Primary outcomes will be the level of self-esteem as measured with Ecological Momentary Assessment using the PsyMate® App and the Rosenberg Self-Esteem Scale. Secondary outcomes will be resilience, emotional well-being, social functioning, quality of life and general psychopathology. Given that exposure to trauma and response to treatment may be reflected at the biological level in distinct epigenetic signatures, levels of DNA methylation in NR3C1 (i.e. glucocorticoid receptor 1 gene) and SLCA4 (i.e. the serotonin transporter gene) will be measured using targeted sequencing.