Background: Adjustment disorder is among the most often diagnosed mental health disorders. Still, there is a lack of specific interventions available for adjustment disorder. Objectives: The aim of this study was to test if an internet-based self-help intervention for adjustment disorder could be effective without therapist involvement. Design: A parallel group randomized controlled trial design was used to test the effectiveness of the Brief Adjustment Disorder Intervention (BADI) – an internet-based intervention for adjustment disorder. Methods: In total 1077 participants were randomized into two conditions: BADI intervention and BADI intervention with therapist support. The main outcome measures were symptoms of adjustment disorder and well-being. Results: Pre-intervention to post-intervention adjustment disorder effect size for the BADI intervention group was d = 0.64, and for the BADI with therapist support group the effect size was d = 0.53. Conclusions: The present study supported the effectiveness of the BADI intervention. Our findings also indicated that adding therapist support to the standard BADI intervention did not significantly improve the outcomes.

Adjustment disorder is one of the most common mental health diagnoses. Still it receives relatively little attention from researchers trying to establish best interventions to treat it. With high prevalence of stressful life events, which might be leading to adjustment disorder, and limited resources of mental health service providers, online interventions could be a very practical way of helping people who have these disorders or are in the risk to develop them. The proposed study protocol is aimed to describe a randomized controlled trial of an internet-based modular intervention for adjustment disorder as it is defined in a proposal for the ICD-11. This study is a two-armed Randomized Controlled Trial (RCT) to examine the effectiveness of a web-based intervention BADI (Brief Adjustment Disorder Intervention) for adjustment disorder symptoms. BADI has four modules: Relaxation, Time management, Mindfulness and Strengthening relationships. It is based on stress and coping research and integrates evidence-based treatment approaches such as Cognitive Behavioural therapy (CBT), mindfulness and body-mind practices, as well as exercises for enhancing social support. Primary outcome of the study are symptoms of adjustment disorder and well-being. Engagement into the program and motivation for change is a secondary outcome. All participants after completing the baseline assessment are randomly assigned to one of the two groups: either to the one in which participant will instantly gain access to the BADI intervention or a group in which participants will be given access to the BADI program after waiting one month. Participants of BADI can choose exercises of the program flexibly. There is no particular order in which the exercises should be completed. Study will provide new insights of modular internet-based interventions efficacy for adjustment disorders. The study will also provide information about the role of motivation and expectancies on engagement in modular internet-based interventions. In case this RCT supports effectiveness of fully automated version of BADI, it could be used very broadly. It could become a cost-effective and accessible intervention for adjustment disorder. The study was retrospectively registered with the Australian and New Zealand Clinical Trials Registry with the registration number ACTRN12616000883415 . Registered 5 July, 2016.

SummaryEpidemiological studies suggest that the vast majority of people experience at least one potentially traumatic event in their lifetime; however, severe posttraumatic stress symptoms affect only few of those ever exposed to trauma. This study has been aimed to find out whether trait resilience and dispositional optimism are associated with trauma experience and a probable Posttraumatic Stress Disorder (PTSD). A cross-sectional study was conducted, enrolling 300 Lithuanian adults of three different age groups. The Life Events Checklist (LEC), Trauma Screening Questionnaire (TSQ), Resilience Scale (RS-14), and Revised Life Orientation Test (LOT-R) were used to measure potentially traumatic events, posttraumatic reactions, psychological resilience, and dispositional optimism. Results of this study revealed a high prevalence of potentially traumatic events among its participants (95%). Nearly 7% of the total sample had probable PTSD. A significant moderate positive relationship was found between the resilience and optimism, r(300) = .40, p < .01. Optimism was negatively associated with PTSD symptoms, r(214) = –.17, p < .05; however, contrary to what was expected, there was no significant association between the trauma reactions and trait resilience.

The Suicidal Ideation Attributes Scale (SIDAS) and the Suicidal Behaviors Questionnaire-Revised (SBQ-R) are widely used psychological instruments for assessing people‘s suicidal ideation and suicidal behavior. The aim of this study was to examine the psychometric characteristics of the Lithuanian versions of the SIDAS and SBQ-R. We analysed data collected from four samples: a Lithuanian general population quota sample based on age, gender and place of residence (N = 697, 52.9% women, aged 18–79 years); a sample of students (N = 2013, 72 % women, aged 18–29 years); a clinical sample of suicidal patients (N = 35, 77.1% women, aged 18–59 years); and a test-retest sample of students who completed the instruments twice within a two-week period (N = 54, 70.4% women, aged 18–47 years). The participants answered questions on gender, and age and completed the SIDAS and SBQ-R. The data analysis revealed that the Lithuanian versions of the SIDAS and SBQ-R have good internal consistency, temporal stability, construct, convergent, and criterion validity. The Lithuanian versions of the SIDAS and SBQ-R can be used to measure suicidality in research settings, as well as in clinical work as auxiliary tools.

Background: There is considerable evidence that outcome expectations may predict psychotherapy outcomes. However, little is known about the long-term outcome expectations following the end of the treatment. Aims: The aim of this study was to evaluate patients’ long-term outcome expectations after trauma-focused post-traumatic stress disorder (PTSD) psychotherapy in a single group effectiveness study. Methods: Twenty participants with various traumatic experiences who completed the Brief Eclectic Psychotherapy for Post-Traumatic Stress Disorder (BEPP) and all the assessments were included into the study. Self-report measures were used to evaluate the therapeutic outcomes: Impact of Event Scale–Revised (IES-R), Clinical Outcomes in Routine Evaluation–Outcome Measure (CORE-OM) at pre-treatment, post-treatment, and 6-month follow-up. Subjective Units of Distress Scale was used to measure long-term outcome expectations at post-treatment, asking participants to measure the expected distress in 6 months following the treatment. Assessments at 6-month follow-up were used to estimate the accuracy of patients’ expectations of their distress at previous post-treatment assessment. Results: Significant decline of PTSD symptoms at post-treatment with large effect sizes was observed. At post-treatment assessment participants expected significant improvement of their condition in 6 months after the treatment. However, therapeutic effects remained stable at the 6-month follow-up. Conclusion: It is concluded that the PTSD patients, even after successful trauma-focused treatment, tend to expect further significant positive changes. However, therapeutic effects were stable half a year after the psychotherapy, and patients tend to have false expectations about further improvement of their condition.

Accessible and effective mental health services for people at risk of suicide are one of the cornerstones of suicide prevention. However, some people suicide while receiving such help, and it is important to understand the reasons for this. In the absence of a direct way to reveal the experiences of people who have received services and subsequently suicided, the professionals providing mental health services are an important source of information on this process. The main aim of this study was to describe the main difficulties experienced by professionals supporting people who later suicided. The sample included 15 mental health professionals (7 psychiatrists, 6 medical psychologists, and 2 social workers) who experienced patient suicide. The data were collected using semi-structured interviews, which were then analysed using thematic analysis. The following themes were identified in the stories of the participants: lack of collaboration from the patient, specific topics that were challenging to work with, treatment limitations, difficulties in assessing suicide risk, reactions experienced when working with the suicidal patient, and the role of the patient’s relatives. Therefore, the results of this study speak about the challenge of being with a patient in a suicidal crisis, who is not inclined to accept help, while bearing the limitations of the system and oneself as a specialist. This causes intense experiences of helplessness and anger.