Purpose: Major Depressive Disorder (MDD) is a pervasive public health challenge, and although exercise therapy shows promise as an adjunct treatment, its inte-gration into routine mental health care remains limited. This study examines the barriers and facilitators to implementing evidence-based exercise therapy for MDD in Dutch specialized mental health care settings. Methods: We explored implementation processes alongside the Exercise Enhances randomized controlled trial. Data were collected through semi-structured interviews with patients (N=6) and with professionals through focus group discussions (N=8) and a questionnaire exploring barriers and facilitators to implementation (N=12). Results: Results indicate that both patients and professionals perceive exercise therapy as beneficial for mood and overall well-being. Key facilitators include the intervention's adaptability, its alignment with existing clinical routines, and the patient-centered support provided by exercise therapists. However, barriers included limited exercise modalities, challenges in adherence to home-based sessions, interprofessional communication gaps, and insufficient organizational resources. Conclusions: While integrating exercise as an adjunct treatment for MDD is feasible and well received, sustained implementation requires enhanced flexibility in program design, improved interdisciplinary collaboration, and dedicated implementation coordination. These insights contribute to the evidence base for scaling exercise interventions within specialized mental health care and underscore the need for structural adjustments and targeted funding.

Physical activity benefits mental health, with emotional autobiographical memory and repetitive negative thinking (RNT) as potential mechanisms. This study expands upon prior laboratory studies by examining how physical activity is associated with emotional autobiographical memory and RNT in daily life, utilizing the experience sampling method (ESM). A community sample (N = 112) was prompted four times daily for seven consecutive days to report their recent physical activity duration and intensity, RNT, recall of a recent personal event, and their current positive and negative mood states. Participants evaluated recalled events as more pleasant when they had been physically active for longer durations or at higher intensities in the preceding hours. No evidence was found for an association between physical activity and RNT. Confirming the mood-enhancing effect of physical activity, both activity duration and intensity were negatively associated with negative mood, and intensity positively with positive mood. The results indicate that physical activity duration and intensity are positively associated with emotional autobiographical memory and mood states. This confirms the mental health benefits of physical activity using daily life data. Future research should further investigate emotional autobiographical memory as a mechanism underlying the protective effects of physical activity on mental health.

Exercise directly improves mood and cognition. Providing exercise immediately before cognitive behavior therapy (CBT) sessions may therefore enhance the clinical responsiveness to CBT. The present pilot study examined the feasibility and direction of effect of exercise+CBT versus CBT in depressed outpatients using a stepped wedged design. Thirty-three patients received either group-based CBT (12-16 weeks) or group-based exercise+CBT within specialized mental healthcare settings. Weekly therapist-supervised exercise sessions (45 min, moderate intensity, running/indoor cycling) were provided directly before the CBT sessions, with encouragement for home-exercise. Feasibility was assessed through recruitment, retention, and safety, alongside treatment adherence and treatment effects on clinically relevant outcomes. Recruitment yielded 37% of eligible patients with similar retention rates across conditions. No adverse events were reported. The exercise+CBT condition attended 63% of supervised exercise sessions (72% at moderate/vigorous intensity) and fewer CBT sessions (42%) compared to the CBT condition (54%). The conditions showed similar improvements in depressive symptoms, rumination, and CBT skills over time. Our study shows in a specialized mental health care routine practice population that providing exercise before CBT sessions is feasible, warranting a future randomized controlled trial.

The theoretical models of Beck and Young predict that Early Maladaptive Schemas (EMSs) are linked to the development and maintenance of mental health problems including depression. The stability of EMSs in daily life are ill-understood despite being a fundamental aspect of cognitive theories. In the current study, we aimed to improve the understanding of EMSs by repeatedly assessing them in daily life under changing contextual triggers and examining the theoretically-grounded associations with mood and rumination. Using factor analysis, we developed a 16-item Ecological Momentary Assessment (EMA) version of the Dutch Young Schema Questionnaire short form (Klynstra et al., 2008). EMSs were assessed six times a day for five days in 90 unselected participants (71

BACKGROUND:Many patients with major depressive disorder (MDD) do not respond sufficiently to first-line treatments. Due to its biological and psychological mechanisms, exercise may enhance the effectiveness of other MDD treatments. In a pragmatic randomised superiority trial, we evaluated the clinical and cost-effectiveness of exercise therapy adjunct to guideline-concordant care as usual (CAU) for MDD in specialised mental health care. METHODS:MDD outpatients (N = 112; Mage = 37; 51% female) were randomized to CAU (96.9% psychotherapy, 59% pharmacotherapy) or CAU + EX (CAU plus 12 weeks of exercise therapy: one supervised and two home-based aerobic sessions/week). Depressive symptoms were assessed using the Inventory of Depressive Symptomatology-Self Report. Remission was evaluated during follow-up by blinded assessors using the Structured Clinical Interview for DSM-5. The economic evaluation followed a societal perspective. RESULTS:Patients in the CAU + EX condition were significantly more likely than those in CAU to meet the exercise prescription; however, only 22% fully adhered to it. Depressive symptoms decreased from severe to moderate depression in both conditions, with no significant difference between the conditions on symptom reduction (b = -0.22, [-0.72, 0.29]) or remission rate (OR = 0.06, [-0.20, 0.32]). Evidence for cost-effectiveness was found in the per-protocol (≥ six supervised exercise sessions) but not in the intention-to-treat sample. CONCLUSIONS:Adjunct exercise therapy does not provide additional clinical benefits or cost-effectiveness in specialized mental health care. Low adherence to the exercise prescription limits its potential. Cost-effectiveness may be achievable with higher adherence, warranting emphasis on strategies to improve adherence in this population.

This research examined the content-specificity of interpretation bias across anxiety, depression and stress symptoms. Moreover, the role of cultural differences in the association between interpretation bias, affective symptoms, and stress experiences was investigated. A sample (N = 234) of Dutch and Chinese participants was recruited during the COVID-19 pandemic restrictions, which acted as a natural stressor. We assessed participants’ interpretation biases specific to content of depressive mood, health threats, and COVID-19 concerns, alongside their symptoms of depression, anxiety, and health anxiety, and experiences of both general and pandemic-induced stress. The findings demonstrated correlations among various interpretation biases, emotional disorder symptoms, and stress experiences. However, linear regression analyses revealed significant associations only between symptom and stress indices and those interpretation biases that shared the same cognitive content. Intriguingly, these relationships did not vary significantly by nationality. These results indicate both a general and a content-specific association between interpretation biases and various emotional disorder symptoms and stress experiences, with a pronounced emphasis on content-specificity. Furthermore, the study suggests a degree of cultural independence in the associations between interpretation biases, symptoms, and stress. These findings provide valuable insights into the manifestation of interpretation bias across different symptoms, stress experiences, and cultural contexts, enhancing our understanding of cognitive theories and their implications.

Our memory is crucial to our daily functioning, our identity, and how we interact with the world around us. Maintaining memory functioning is therefore important in many ways. Exercise positively affects our memory. Even a single exercise session can directly boost different memory types, including working, procedural, and episodic memory. Due to these benefits, exercise has great potential as an intervention in different settings, such as schools or rehabilitation centers, and as a prevention strategy. In this chapter, we first give an overview of what memory is and why it is so relevant to our mental health. Next, we briefly discuss how, for whom, and under which circumstances exercise improves memory functioning. Then, we will summarize the literature of experimental studies investigating the direct effect of exercise on different memory types, while acknowledging current limitations and potential future directions. Finally, we briefly highlight the potential of exercise as intervention to preserve and improve memory.

Although it is well known that exercise reduces depressive symptoms, the underlying psychological mechanisms remain unclear. This experimental study examined the acute effect of exercise on mood, and depressotypic memory bias and state rumination. Trait rumination was tested as a possible moderator. A sample of non-regular exercisers (N = 100) was randomized to exercise or rest. After a negative mood induction, the exercise condition cycled for 24 min at moderate intensity, while the rest condition rested. Negative and overgeneral memory bias, as well as positive and negative affect were assessed after exercise/rest. To capture the lingering of negative mood and state rumination, both were assessed multiple times throughout the study. The exercise (as compared to rest) condition reported more positive affect. However, no differences were found on overgeneral memory bias, as well as depression-specific mood or state rumination measured throughout the study. Interestingly, the exercise condition showed more negative memory bias at higher levels of rumination. Individual differences in trait rumination moderated the exercise-memory bias relation, such that exercise increased negative memory bias at higher levels of rumination. It is possible that long-term exercise protocols are necessary to change cognitive processes related to depression.

Background: Anhedonia is a common symptom of several disorders, but cost-effective treatments that focus on anhedonia specifically have been lacking. Therefore, personalized lifestyle advice has recently been investigated as a suitable means of enhancing pleasure and positive affect (PA) in young adults with anhedonia. This intervention provided individuals with a personalized lifestyle advice which was based on observed individual patterns of lifestyle behaviors and experienced pleasure in daily life. The present study extends this previous work by examining a potential mechanism of treatment success, affective reactivity. Methods: We explored changes in affective reactivity to events in daily life from pre- to post-intervention in a subclinical sample of young adults with anhedonia (N = 69). Using the Experience Sampling Method (ESM), participants answered questions on their activities, their pleasure levels, PA and negative affect (NA) before and after the intervention. Results: Multilevel analysis revealed that participants did not experience an altered affective reactivity to positive events after the intervention. The affective reactivity to negative events depended on the level of improvement in mean-PA after the lifestyle advice intervention. Limitations: The present study used a subclinical sample with the majority of participants being female which limited the generalizability of the findings. Conclusion: This study suggests that an altered affective reactivity to negative events is an underlying mechanism of the effectiveness of a personalized lifestyle advice.

Purpose Given the complex association between substance use disorders (SUD), comorbid mental health problems and criminal recidivism in forensic patients, homogenous patient classes can contribute to a refined treatment. This paper aims to construct those classes in forensic patients (N = 286) diagnosed with SUD, unconditionally released between 2004 and 2013 of one of ten Dutch forensic psychiatric centers. Design/methodology/approach Retrospective data were derived from electronic patient files. Classes were based on the Dutch risk assessment tool, the Historisch Klinisch Toekomst-Revisie (Historical Clinical Future–Revised [HKT-R]) and identified by means of explorative Latent Class Analysis in Latent Gold version 5.1. In a three-step approach, posterior class memberships were related to external variables (i.e. diagnoses, type of drug and type of offence). Findings Four classes were identified that differ in the risk of recidivism, as well as Axis I and II diagnoses and type of drug consumption. Practical implications This study informed on the heterogeneity of forensic patients with SUD and identified four homogenous classes that differ in important variables for the treatment approach. Based on these classes, a more refined treatment approach can be developed. Possible treatment approaches are discussed, but future research is needed to provide evidence. Originality/value This study is the first to identify classes within forensic patients with SUD and, therefore, sets the first step to develop a tailored treatment approach based on characteristics informative for treatment.