Christine Knaevelsrud

• Freie Universität Berlin

Objective: Individuals who experienced childhood maltreatment show an increased sensitivity to stressful events and are at greater risk for adult psychopathology. Leveraging the natural event of unintended pregnancy, this study aimed (a) to examine heterogeneity in posttraumatic stress disorder (PTSD) trajectories in the context of a stressful life...

Internet-based interventions (IBIs) are effective for treating depression, but they can also lead to negative effects in some participants. There is no consensus on which specific characteristics of negative effects clinicians and researchers should focus on. Studies often combine distinct (sub)categories of negative effects, complicating interpret...

Background: Childhood maltreatment increases the risk for mental disorders, including postpartum depression (PPD). Outside the peripartum period, attenuated long-term hypothalamus-pituitary-adrenal (HPA) axis regulation and perceived chronic stress are discussed as potential mechanisms underlying the adverse effects of childhood maltreatment. Hair...

Background: Decades of research on the dimensional nature of personality disorder (PD) have led to the replacement of categorical PD diagnoses by a dimensional assessment of PD severity (PDS) in ICD-11, which essentially corresponds to personality functioning in the alternative DSM-5 model for PDs. Besides advancing the focus in the diagnosis of PD...

Background. Evidence suggests that blended therapy, which combines face-to-face psychotherapy with digital components, has the potential to reduce treatment dropout rates. However, there is inconsistency in how treatment dropout is defined in the blended therapy context. The combination of face-to-face and digital components adds complexity to pote...

Introduction Despite CBT’s status as a first-line treatment, a substantial proportion of patients does not experience sufficient symptom relief. Recent advances in wearable technology and smartphone integration enable new, ecologically valid approaches to capture dynamic processes in real time. By combining ecological momentary assessment (EMA) wit...

Background Internet-Based Interventions (IBIs) are effective treatments for mental disorders, but their implementation faces challenges, particularly in addressing high dropout rates. Adding more human support or guidance might reduce treatment dropout rates in IBIs, but it may also limit scalability. Therefore, small, easy-to-implement, guidance-b...

Introduction Cognitive–behavioural therapy (CBT) works—but not equally well for all patients. Less than 50% of patients with internalising disorders achieve clinically meaningful improvement, with negative consequences for patients and healthcare systems. The research unit (RU) 5187 seeks to improve this situation by an in-depth investigation of th...

Childbirth-related posttraumatic stress symptoms (CB-PTSS) affect around 12% of postpartum individuals. While the subjective experience of childbirth is a key predictor of CB-PTSS, the specific defining characteristics of negative birth experiences remain poorly understood. This study aims to refine our understanding of negative birth experiences b...

Background: Internet-based interventions (IBIs) offer the potential for personalization through various mechanisms and components. Objective: This systematic review aimed to synthesize evidence on the personalization of treatment components within IBIs targeting diverse mental health conditions. Specifically, we focused on studies that directly com...

Background Internet-based interventions (IBIs) are a low-threshold treatment for individuals with depression. However, comparisons of IBI against unstandardized care-as-usual (CAU) are scarce. Moreover, little evidence is available if IBI has an add-on effect for individuals already receiving an evidence-based treatment such as antidepressants and/...

Background Childhood maltreatment (CM) significantly increases the risk of developing post-traumatic stress disorder (PTSD) for which the prevalence in Europe is higher than initially assumed. While the high economic burden of PTSD is well-documented, little is known about the health care cost differences between individuals with PTSD-CM and those...

Objective. Clinical care and research need to improve treatment availability for auditory verbal hallucinations (AVH). To provide further evidence, we examined the efficacy of an unguided six-weeks self-help intervention for AVH (SH-MCTAVH) based on metacognitive training. Methods. N = 78 participants with distressing AVH were recruited from clinic...

Randomized controlled trials are the gold standard for evaluating internet-based interventions (IBIs). However, their value depends on whether the estimated treatment effect accurately reflects its intended meaning. Unfortunately, this is not always the case. Decisions addressing so-called intercurrent events, such as treatment discontinuation, can...

Background: To better understand heterogeneity in PTSD development and to ensure that knowledge of risk and intervention mechanisms is available for a diverse group of trauma exposed individuals, psychotraumatology needs to consider diversity in sample characteristics. Objective: In a comprehensive overview, we evaluated how nine diversity domains...

Zusammenfassung Einleitung Barrieren beim Zugang zur Schwangerschaftsabbruchversorgung können die Inanspruchnahme von Versorgungsleistungen verzögern, was zu einem zeitlich verzögerten Schwangerschaftsabbruch und gesundheitlichen Risiken führen kann. Zu Barrieren gehören u. a. die räumliche Erreichbarkeit, Geheimhaltung, Wartezeiten, Stigmatisieru...

Background. Internet-Based Interventions (IBIs) are effective treatments for mental disorders, but their implementation faces challenges, particularly in addressing high dropout rates. Adding more human support or guidance might reduce treatment dropout rates in IBIs, but it may also limit scalability. Therefore, small, easy-to-implement, guidance-...

Background Sexual trauma in the context of conflict and displacement is considered one of the most serious and stigmatising forms of human rights violations. Although it has occurred throughout history, research data on this topic is scarce, especially regarding male survivors and Arabic-speaking countries. In the present study, we examined sexual...

Background Reproductive mood disorders indicate that within-person variation in depressive symptoms across the menstrual cycle can be related to ovarian hormone changes. Until now, such cycle-related symptom changes have been measured once daily, even though depression research indicates systematic diurnal changes in symptoms. Further, previous res...

Objective: Individuals who experienced childhood maltreatment show an increased sensitivity to stressful events and are at greater risk for adult psychopathology. The present study for the first time investigates whether childhood maltreatment is a risk factor for posttraumatic stress disorder (PTSD) symptoms in the context of unintended pregnancy,...

Randomized controlled trials are routinely used to assess the efficacy of psychotherapy. To date, our knowledge about how patients experience participation in such a trial is scant. Therefore, the present analysis aims at an in-depth exploration of patients’ perspectives on how a trial environment affects them. This study was conducted within the f...

Background: Blended Care (BC) is thought of as a promising approach to enhance psychotherapy (PT) effects by increasing its effectiveness and decreasing therapy sessions.Method: This randomized controlled trial aimed to investigate the usage, implementation, and effectiveness of BC with transdiagnostic and transtheoretical online modules compared t...

Introduction: Psychotherapists may act as bottlenecks in the integration of digital interventions into psychotherapy, known as blended care (BC). In the literature, various factors are discussed as potential inclusion, exclusion, or limiting criteria in BC.Method: Our aim for this interview study was to gain a deeper understanding of the factors ps...

Qualitative investigations that openly explore changes and facilitators of changes from the patient's perspective might offer valuable insights on impacts of therapy and helpful and hindering aspects. Our aim for this study was to explore the perspective of patients on a transdiagnostic Internet-based intervention to understand (1) which changes (p...

Background Digital mental health interventions for smartphones, such as the World Health Organization (WHO) Step-by-Step (SbS) program, are potentially scalable solutions to improve access to mental health and psychosocial support in refugee populations. Our study objective was to evaluate the effectiveness of SbS as self-guided intervention with o...

Purpose To assess gender differences in COVID-19 related changes in home and work responsibilities longitudinally, and determine whether these differences, together with other potential risk and protective factors, are associated with depression, anxiety, and post-traumatic stress disorder (PTSD) symptomatology. Method Symptoms of depression, anxi...

The Hierarchical Taxonomy of Psychopathology (HiTOP) arranges phenotypes of mental disorders based on empirical covariation, ranging from narrowly defined symptoms to higher-order spectra of psychopathology. Since the introduction of personality functioning (PF) in DSM-5 and ICD-11, several studies have identified PF as a predictor of transdiagnost...

Decades of research on the dimensional nature of personality disorder (PD) have led to thereplacement of categorical PD diagnoses by a dimensional assessment of personalitydysfunction severity (PDS) in ICD-11, which essentially corresponds to the dimensional PDmodel in Section III of DSM-5. Besides advancing the focus in the diagnosis of PD onimpai...

Background: Decades of research on the dimensional nature of personality disorder (PD) have led to the replacement of categorical PD diagnoses by a dimensional assessment of PD severity (PDS) in ICD-11, which essentially corresponds to personality functioning in the alternative DSM-5 model for PDs. Besides advancing the focus in the diagnosis of PD...

Background In recent years, a growing body of evidence has demonstrated the efficacy of non-pharmacological interventions for schizophrenia spectrum disorders (SSD) including positive symptoms such as auditory hallucinations (AH). However, clinical trials predominantly examine general treatment effects for positive symptoms. Therefore, previous res...

Background Research on cultural adaptation of psychological interventions indicates that a higher level of adaptation is associated with a higher effect size of the intervention. However, direct comparisons of different levels of adaptations are scarce. Aims This study used a smartphone-based self-help programme called Step-by-Step (Albanian: Hap-...

People make countless decisions every day. We explored the self-regulatory function of decisions and assumed that the very act of making a decision in everyday life enhances people’s mood. We expected that this decision-related mood change would be more pronounced for intuitive decisions than for analytical ones. The ease of making a decision and t...

Zusammenfassung Ziel der Studie Dolmetschende spielen eine entscheidende Rolle bei der Versorgung von Geflüchteten. Allerdings wird der psychischen Gesundheit von Dolmetschenden bisher nur wenig Beachtung gegeben. Trotz eines erhöhten Belastungslevels von sekundärem traumatischem Stress (STS) und gesteigerten Prävalenzen Posttraumatischer Belastung...

Women are at higher risk than men for developing posttraumatic stress disorder (PTSD), but underlying mechanisms are still unclear. Comprehensive knowledge about these mechanisms is necessary to develop tailored, sex- and gender-sensitive preventive interventions. This systematic review and meta-analysis examined sex-/gender-dependent risk factors,...

Background Syrian refugees have a high burden of mental health symptoms and face challenges in accessing mental health and psychosocial support (MHPSS). This study assesses health system responsiveness (HSR) to the MHPSS needs of Syrian refugees, comparing countries in Europe and the Middle East to inform recommendations for strengthening MHPSS sys...

Internet‐based interventions have proven to be effective for the treatment of depression in different samples, but evidence from the Middle East and North Africa (MENA) region is scarce. The aim of this study was to investigate the acceptance and efficacy of an internet‐based cognitive behavioural writing intervention for Arabic‐speaking participan...

Objective: Depressive symptom dynamics, including change trajectories and symptom variability, have been related to therapy outcomes. However, such dynamics have often been examined separately and related to outcomes of interest using two-step analyses, which are characterized by several limitations. Here, we show how to overcome these limitations...

Childbirth can be a highly stressful event, in some cases leading to posttraumatic stress symptoms. While the subjective experience of childbirth (SBE) is a key predictor of childbirth-related posttraumatic stress symptoms (CB-PTSS), the specific defining characteristics of stressful birth experiences remain poorly understood. This study aims to sh...

Childbirth can be a highly stressful event, in some cases leading to posttraumatic stress symptoms. While the subjective experience of childbirth (SBE) is a key predictor of childbirth-related posttraumatic stress symptoms (CB-PTSS), the specific defining characteristics of stressful birth experiences remain poorly understood. This study aims to sh...

Introduction: Internet-based interventions (IBI) can increase access to evidence-based treatments for mental disorders, but knowledge of their mechanisms of change is limited. Self-efficacy is an important common factor of psychotherapy and is especially interesting in IBI given its self-help focus. We investigated self-efficacy as an outcome, pred...

The Hierarchical Taxonomy of Psychopathology (HiTOP) arranges phenotypes of mental disorders based on empirical covariation, ranging from narrowly defined symptoms to higher-order spectra of psychopathology. Since the introduction of personality functioning (PF) in DSM-5 and ICD-11, several studies have identified PF as a transdiagnostic predictor...

Background Internet-based interventions offer a way to meet the high demand for psychological support. However, this setting also has disadvantages, such as the lack of personal contact and the limited ability to respond to crises. Blended care combines Internet-based interventions with face-to-face psychotherapy and merges the benefits of both set...

Background Approximately 50% of rare diseases have symptom onset during childhood. A high level of nursing care and an often uncertain prognosis put caregivers of the affected children at high risk for psychological distress. At the same time, their caregivers have limited access to appropriate psychological care. The aim of this study was to evalu...

b> Hintergrund: Taube Menschen begegnen als sprachliche Minderheit im psychiatrisch-psychotherapeutischen Versorgungssystem zahlreichen Barrieren. Mental Health Literacy (MHL), die für Erkennen, Behandlung und Hilfesuchverhalten bei psychischen Störungen essenziell ist und den Umgang mit Belastungen prägt, wurde bei Tauben Menschen bislang nicht un...

Background: Menstrual cycle regularity is an important marker of reproductive health and associated with physiological and psychological illnesses, as well as experiencing stress. We hypothesized that individuals with irregular menstrual cycles report higher depressive symptom severity, after controlling for stress occurrence. Methods: The hypot...

Background Refugee populations have an increased risk for mental disorders, such as depression, anxiety, and posttraumatic stress disorders. Comorbidity is common. At the same time, refugees face multiple barriers to accessing mental health treatment. Only a minority of them receive adequate help. The planned trial evaluates a low-threshold, transd...

Background During the COVID-19 pandemic, the global population was exposed to a significant psychological distress, however, subgroups of vulnerable individuals proved resilient throughout the pandemic. This study aims to identify predictors of long-term, sustained resilience among people with a history of mental disorder during the first two years...

BACKGROUND There is evidence from meta-analyses and systematic reviews that digital mental health interventions for depression, anxiety and stress-related disorders tend to be cost-effective. However, no such evidence exists for guided digital mental healthcare in low and middle-income countries facing humanitarian crises, where needs are highest....

Background There is evidence from meta-analyses and systematic reviews that digital mental health interventions for depression, anxiety, and stress-related disorders tend to be cost-effective. However, no such evidence exists for guided digital mental health care in low and middle-income countries (LMICs) facing humanitarian crises, where the needs...

Background Internet-based interventions produce comparable effectiveness rates as face-to-face therapy in treating depression. Still, more than half of patients do not respond to treatment. Machine learning (ML) methods could help to overcome these low response rates by predicting therapy outcomes on an individual level and tailoring treatment acco...

Background Refugees are at high risk for developing mental illnesses. Due to language and cultural barriers, there is need for specifically adapted therapeutic procedures for refugees in inpatient mental health care settings. Internet-based applications in refugee mother tongues have the potential to improve the outcomes of mental health care for t...

Background Cognitive behavioral interventions delivered via the internet are demonstrably efficacious treatment options for posttraumatic stress disorder (PTSD) in underserved, Arabic-speaking populations. However, the role of specific treatment components remains unclear, particularly in conflict-affected areas of the Middle East and North Africa....

Psychotherapy is effective in treating mental disorders; however, not all patients benefit to the same extent and treatment gains are not always maintained. Blended care (BC) has the potential to improve psychotherapeutic care by combining traditional psychotherapy with online contents. To explore the potential of BC for psychotherapeutic care and...

Background: Mental disorders impact both individuals and health systems. Symptoms and syndromes often remain undetected and untreated, resulting in chronification. Besides limited health care resources, within-person barriers such as the lack of trust in professionals, the fear of stigmatization, or the desire to cope with problems without professi...

Adverse social and economic conditions negatively impact mental health and well-being. The present systematic review is the first to investigate the association between housing insecurity and mental health outcomes among renters, with a focus on housing affordability and instability. We followed the Preferred Reporting Items for Systematic reviews...

Women are at higher risk than men for developing posttraumatic stress disorder (PTSD), but underlying mechanisms are still unclear. Comprehensive knowledge about these mechanisms is necessary to develop tailored, sex- and gender-sensitive preventive interventions. This systematic review and meta-analysis examined sex/gender-dependent risk factors,...

Background It is a precondition for evidence-based practice that research is replicable in a wide variety of clinical settings. Current standards for identifying evidence-based psychological interventions and making recommendations for clinical practice in clinical guidelines include criteria that are relevant for replicability, but a better unders...

b> Background: Current guidelines recommend phase-based approaches such as Skills Training in Affective and Interpersonal Regulation/ Narrative Therapy (STAIR/NT) for the treatment of posttraumatic stress disorder (PTSD) following complex traumatization. However, to date there is no systematic review on the efficacy of STAIR as initial treatment ph...

Objectives: The aim of this study was to develop and validate a questionnaire to assess interpreters’ role conflicts and the challenging aspects within the triad of practitioner, interpreter and refugee client. Methods: A questionnaire was developed based on previous literature. Its factor structure and construct validity were assessed in an online...

Background The loss of a significant other can lead to variety of responses, including prolonged grief disorder (PGD), depression, and posttraumatic stress disorder (PTSD). Latent class analysis (LCA) is a person-centered statistical approach that finds subtypes of related cases based on item-responses. There has been a growing interest in conduct...

Background About 50% of rare diseases have symptom onset during childhood. A high level of nursing care and an often uncertain prognosis put caregivers of the affected children at high risk for psychological distress. At the same time, their caregivers have limited access to appropriate psychological care. Aim of this study was to evaluate a web-ba...

The COVID-19 pandemic has been negatively associated with mental health. However, little is known about the temporal dynamics of mental health in the longer term of the pandemic. We aimed to investigate symptom levels and changes of depression, anxiety, posttraumatic stress, and loneliness spanning two years of the pandemic; and to examine associat...

BACKGROUND Cognitive behavioral interventions delivered via the internet are demonstrably efficacious treatment options for posttraumatic stress disorder (PTSD) in underserved, Arabic-speaking populations. However, the role of specific treatment components remains unclear, particularly in conflict-affected areas of the Middle East and North Africa....

Background: Pre-and post-traumatic hypothalamic-pituitary-adrenal (HPA) axis markers have been studied to predict posttraumatic stress disorder (PTSD) risk, but its acute reactivity cannot be measured in real-life settings. Experimental paradigms can depict the cortisol response to stimuli that simulate traumatic events.Objective: To review experim...

E-mental health interventions may offer innovative means to increase access to psychological support and improve the mental health of refugees. However, there is limited knowledge about how these innovations can be scaled up and integrated sustainably into routine services. This study examined the scalability of a digital psychological intervention...

Seit 2020 können Psychotherapeut*innen in Deutschland sog. Digitale Gesundheitsanwendungen (DiGA) verordnen. Damit wurde erstmals die Voraussetzung geschaffen, dass Menschen mit psychischen Störungen im Rahmen ihrer gesetzlichen Krankenversicherung digitale Angebote nutzen. Aber was sind DiGA, welche gibt es überhaupt und welchen Nutzen können sie...

Introduction: Psychotherapeutic interventions for major depressive disorder (MDD) have been suggested to beassociated with a normalization of biological stress system (i.e., the hypothalamic-pituitary-adrenal axis and theautonomic nervous system) dysregulation. Furthermore, pre-intervention cortisol parameters have been identifiedas prescriptive bi...

The loss of a significant other can lead to prolonged grief disorder (PGD), depression, and posttraumatic stress disorder (PTSD). Latent class analysis (LCA) is a statistical approach that finds subtypes of related cases based on item-responses. There has been a growing interest in conducting LCA on PGD, but no research synthesis exists yet. This s...

Sex disparities are evident in the biological response to acute stressors, with a suggested influence of ovarian hormones on hypothalamic-pituitary-adrenal (HPA) axis functioning. This systematic review and meta-analysis investigates differences in HPA axis reactivity to acute psychosocial or physiological stressors between menstrual cycle phases....

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Background: Internet-based interventions offer a way to meet the high demand for psychological support. However, this setting also has disadvantages, such as the lack of personal contact and the limited ability to respond to crises. Blended care combines Internet-based interventions with face-to-face psychotherapy and merges the benefits of both se...

Symmetrical bifactor models are frequently applied to diverse symptoms of psychopathology to identify a general P factor. This factor is assumed to mark shared liability across all psychopathology dimensions and mental disorders. Despite their popularity, however, symmetrical bifactor models of P often yield anomalous results, including but not lim...

Introduction: Psychotherapeutic interventions for major depressive disorder (MDD) have been suggested to be associated with a normalization of biological stress system (i.e., the hypothalamic-pituitary-adrenal axis and the autonomic nervous system) dysregulation. Furthermore, pre-intervention cortisol parameters have been identified as prescriptiv...

Introduction Refugee youth are often faced with the compounding challenges of heightened exposure to traumatic events and acculturating to a new country during a developmental period when their sense of self is still forming. This study investigated whether refugee youth’s acculturation orientation (separation, integration, marginalization, and ass...

Background: There is a need for an interview-based measure to assess Prolonged Grief Disorder (PGD) included in the text revision of the fifth Diagnostic and Statistical Manual for Mental Disorder (DSM-5-TR) and 11th edition of the International Classification of Disease (ICD-11). We evaluated the psychometric properties of the Traumatic Grief Inv...

Background Refugee populations have an increased risk for mental disorders, such as depressive, anxiety, and posttraumatic stress disorders. Comorbidity is common. At the same time, refugees face multiple barriers to accessing mental health treatment. Only a minority of them receives adequate help. The planned trial evaluates a low-threshold, trans...

Objective: To investigate the differential effects of an internet-based cognitive-behavioral writing therapy (iCBT) on post-traumatic stress disorder (PTSD) symptoms after intensive care in patients and their spouses. Methods: This reanalysis of a randomized controlled trial compared PTSD symptom severity (measured by PCL-5) before and after the...

Background The mental health burden among refugees in high-income countries (HICs) is high, whereas access to mental healthcare can be limited. Objective To examine the effectiveness of a peer-provided psychological intervention (Problem Management Plus; PM+) in reducing symptoms of common mental disorders (CMDs) among Syrian refugees in the Nethe...

Etiological theories on the development of psychopathology often incorporate adverse childhood experiences (ACE) as an important contributing factor. Recent studies suggest personality functioning (PF; i.e., stability of the self and interpersonal relationships) as an important transdiagnostic construct that could be useful in better understanding...

Objective: Applying elements of cognitive behavioral therapy (CBT) in internet-based interventions (IBIs) is effective in treating depression. However, CBT-based IBIs differ in which kind of components are applied and the order of their application. Furthermore, it is as yet unknown whether such sequencing matters. Using an IBI for depression, we...

Background: Syrian refugees have a high burden of mental health symptoms and face challenges in accessing mental health and psychosocial support (MHPSS). This study assesses health system responsiveness (HSR) to the MHPSS needs of Syrian refugees, comparing countries in Europe and the Middle East to inform recommendations for strengthening MHPSS sy...

Hintergrund: In bisherigen vorwiegend qualitativen Studien berichteten Dolmetschende häufig von belastenden und komplexen Arbeitssituationen in der Geflüchtetenhilfe. Ziel der vorliegenden Studie war es daher, die Bedürfnisse und Arbeitsbedingungen quantitativ zu untersuchen. Methode: Im Rahmen einer Online-Befragung wurden verschiedene Faktoren be...

Background: A dissociative subtype of posttraumatic stress disorder (D-PTSD) was introduced into the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) but latent profiles and clinical correlates of D-PTSD remain controversial. Objective: The aims of our study were to identify subgroups of individuals with distinct...

BACKGROUND Mental disorders impact both individuals and health systems. Symptoms and syndromes often remain undetected and untreated, resulting in chronification. Besides limited healthcare resources, within-person barriers contribute to the treatment-gap and impede early treatment seeking. These include a lack of trust in professionals, fear of st...

Objective: Individuals with low socioeconomic status (SES) have significantly higher prevalence rates of mental disorders than those with higher SES, but are less likely to receive treatment. Studies from the United States show that individuals with higher SES are more likely to be offered a therapy place than those with low SES. In Germany, where...

The Brief Experiential Avoidance Questionnaire (BEAQ) is a 15-item short form of the Multidimensional Experiential Avoidance Questionnaire. This study aimed to investigate psychometric properties of a German translation of the BEAQ in a student and a clinical population. The BEAQ showed high internal reliability and overall acceptable convergent an...

Background In blended therapy, face-to-face psychotherapy and Internet-based interventions are combined. Blended therapy may be advantageous for patients and psychotherapists. However, most blended interventions focus on cognitive behavioral therapy or single disorders, making them less suitable for routine care settings. Methods In a randomized c...