Conference Agenda

Background:

Common mental health disorders (CMD) are characterized by fluctuating symptoms and interpersonal stressors that are often inadequately addressed by traditional, weekly therapeutic models. Ecological Momentary Interventions (EMI) offer a solution by delivering real-time personal support. However, the specific mechanisms of action, optimal delivery contexts, and user-led design requirements for these digital tools remain under-explored. This presentation synthesises findings from two interrelated studies to evaluate the feasibility, acceptability, and mechanism of automated mentalization-based EMIs for individuals and couples.

Methods:

Study 1: 84 participants with CMDs were randomized to a 4-week automated mindfulness or mentalization EMI. Study 2: A couples based mentalization EMI was coproduced with 10 couples, followed by a feasibility and acceptability study with 20 cohabiting couples.

Results:

Study 1: The RCT demonstrated high retention (89.2%) and adherence (87.7%). Both interventions yielded significant within-group reductions in depression and anxiety with moderate-to-large effect sizes (d = -0.68 to -0.81). Study 2: The analysis of the couples study is underway and will be presented.

Conclusion:

Mentalization-based EMIs are feasible, acceptable, and clinically promising. However, a finding that moments of high need is not always a moment for greatest receptivity, indicated the need for more context-sensitive design that align with a user’s immediate capacity to engage during moments of crisis.

Background

People with mild to borderline intellectual disabilities (MBID) are likely to experience difficulties with mentalising. To practice skills important for mentalising, a serious game titled ‘You & I’ was developed. A randomised controlled trial (2018-2019; Derks et al., 2024) and a supplemental quasi-experimental study (2021-2022; Mesker et al., revised), in which people with MBID played the game together with a professional caregiver, yielded no improvements in mentalising, but did show improvements in stress regulation. However, in the quasi-experimental study, conversations during play were audio-recorded, providing valuable insights into the support offered by professional caregivers. The aim of this study is to analyse how professional caregivers were naturally using mentalising skills during collaborative play, and to identify opportunities to further structure and strengthen professional caregivers’ support of mentalising.

Methods
This qualitative study included 82 participants. Audio-recordings of collaborative gameplay were transcribed verbatim and analysed using ATLAS.ti. Two independent coders analysed the data (deductive coding) and discussed coding discrepancies until consensus was reached. The data were coded for mentalising-related language e.g. mirroring of emotions and thoughts of both the game character and the person with MBID; links to real-life experiences such as inviting the player to reflect on how they would respond in a similar situation; conversations about the expression of emotions and feelings; and ‘other’ mentalising skills.

Results
Initial analyses show that, while the nature and depth of support during play varied, some professional caregivers naturally support mentalising skills e.g. by mirroring emotions and thoughts and connecting the game content to real-life experiences.

Conclusion
These findings suggest that although some professional caregivers naturally use mentalising skills during collaborative play, more consistent and structured facilitation is needed. Developing a practical guideline may help professional caregivers provide this support more reliably and could therefore improve the serious game’s effectiveness.

Background

Professional caregivers play a vital role in building meaningful and trusting relationships with people with intellectual disabilities. Central to fostering these relationships is mentalisation, which involves the ability to understand and interpret mental states in oneself and others. However, mentalising can be challenging in care settings, particularly when working with people with intellectual disabilities who often struggle to reflect on their thoughts and feelings and express their emotions. Moreover, high workloads and frequent staff turnover further complicate effective mentalisation in professional caregivers. Therefore, a Virtual Reality (VR) group intervention has been developed to support professionals in practicing mentalisation. Evidence from a prior randomised trial is encouraging but remains limited. Hence, this study aims to adapt the VR group intervention to enhance professional caregivers’ learning outcomes.

Methods

This study used a design-based approach to iteratively refine the VR group intervention, comprising (1) preparatory knowledge clips about mentalisation, (2) immersive VR practice, and (3) a plenary debriefing after each participant’s VR interaction. Two groups of eight professional caregivers participated in iterative co-creative sessions. In each session, participants experienced the intervention and provided feedback on user experience, relevance, and implementation conditions.

Results

Feedback from professional caregivers identified facilitating and hindering factors across the intervention’s components, including more concise and engaging knowledge clips, more natural avatar responses, and a debriefing with more structured discussion. These findings led to refinements in the next iteration.

Conclusion

This study provides insights into the adaptations made to maximise the intervention’s potential. By supporting professional caregivers in making sense of behaviour in terms of underlying mental states and adjusting their responses accordingly, the intervention may contribute to meaningful relationships with people with intellectual disabilties. A subsequent study will investigate whether the VR intervention effectively increases professional caregivers’ mentalisation skills.

Discussant