Central German Mental Health Center

In the following we want to illustrate our previous own work by structuring it according to translational steps. It demonstrates the comprehensive approach of CMC from uncovering fundamental processes and mechanisms leading to mental disorders up to transfer of recommendations into every-day care and public outreach.

T0: Discovery, novel cellular and animal models

As the diagnostic criteria for mental disorders are behaviourally defined, our expertise is in providing novel tools for behavioural phenotyping in rodent models, by exploiting ultrasonic vocalizations in rats, e.g. for measuring DEP-related affective state or social functioning relevant to ASD.

Behavioural phenotyping is combined with in vitro and in vivo electrophysiological recordings as well as in silico studies in artificial neurons and multiscale computer simulations for neuronal plasticity.

T1: Basic cognitive-emotional mechanisms, their neural correlates and proof of principle in healthy humans

The unique expertise of CMC encompasses the thorough characterisation of cognitive-emotional processes in humans, from basic action-perception and conditioning to social and expectation levels.

We characterise cognitive-emotional processes in developmental trajectories from birth to adulthood in large cohorts following them for years, e.g. on movement, attention, affect, (face) perception, (implicit) memory, theory of mind/empathy and their interactions.

A closely related expertise of the CMC is the transfer of these highly sophisticated experimental paradigms into an MRT brain scanning environment.

Another worldwide expertise of the CMC is research on placebo mechanisms. We induced positive and negative expectations in healthy controls and DEP, with placebo applications and active drugs (e.g. ketamine). This provided us with a broad expertise to better understand syndromes, but most importantly, to design better treatment trials.

We have done extensive translational work to elucidate mechanisms that lead from genetic and environmental risk to functional and structural brain alterations.

In terms of advanced methods, we have developed MRT pipelines for multicentre (f)MRT studies in patients. Further, we have been upscaling machine learning techniques for modelling behaviour, closing the loop with experimental psychology.

T2: Novel methods for prevention, diagnosis and therapy, patient studies, clinical trials

We have been closing the translational gap between T1 and T2 by using the entire range of cognitive-emotional processes discovered by cognitive (neuro-)science and applied these to explain and target disordered functions in patients.

We uncovered the processes relevant for successful psychotherapy, applying them to novel interventions, e.g. tDCS stimulation with the ultimate goal of precision psychotherapy.

In large randomised, multicentre psychotherapy trials of CBT in SZ and ANX, we combined fMRT, electrophysiology and GWAS to map neural correlates and predict success of psychotherapeutic interventions.

Inspired by placebo research, we investigated the mechanism of expectation as a crucial factor to understand development, maintenance, and change of mental disorders. Accordingly, we have developed a brief “expectation-optimization intervention” that is suitable not only for mental disorders, but also medical conditions.

Our large, longitudinal, deeply phenotyped patient cohorts have resulted in breakthrough studies shaping our understanding of diagnoses and heritability across diagnostic categories. We have developed novel machine learning methods, e.g. for making use of large-scale electronic health records.

T3: Translation of new evidence into health-care

In large RCT psychotherapy studies, we have developed and tested innovative treatment options, for example intensified exposure based psychotherapy for ANX, the efficacy of psychodynamic therapy and CBT in social anxiety, PTSD, CBT vs psychoeducation in recurrent depression, CBT plus emotion regulation vs. CBT in somatoform disorders, or optimizing outcome expectations in cardiac surgery patients.

Results of our studies have entered national and international guidelines, with CMC faculty having been involved in those for ASD, DEP, ANX, PTSD, ADHD, social ANX, SOM, acute stress disorder, body dysmorphic disorder, suicidal and non-suicidal self-injury behaviour in childhood and adolescence, psychological aspects in diabetes and quality assurance in psychotherapy.

For example, in a study leading to the new DSM-5 conceptualization of ASD, we showed that ASD subtypes are not qualitatively distinct diseases, but rather different quantitative manifestations of the same disorder. CMC faculty is part of the ICD-11 working group on somatoform disorders and chronic pain as well as ASD. We were also able to stimulate a new classification system for chronic pain that was adapted for ICD-11 by the World Health Assembly.

The transfer of recommendations into every-day care is still hindered by multiple obstacles that the CMC tries to identify and circumvent. For example, we developed a stepped-care age-appropriate approach in ADHD (e.g. ESCAlife; we tested the quality of paediatric outpatient care across Europe; and the patient perspective of what constitutes a preferential therapeutic outcome was evaluated (N=4791).

T4: Alliances with transfer partners

The CMC has facilitated the transfer of evidence-based psychotherapy into clinical practice by the publication of various treatment manuals (e.g. for DEP, SZ, PTSD, sexual addiction, problems in diabetes, social ANX, body dysmorphic disorder, trauma-related disorders) and many textbooks for students and postgraduate training. We have developed patient-centred apps, e.g. a comprehensive diagnostic app for mental and physical illnesses by the ADA company which is used worldwide, a prevention app of depression for students, and the assessment and treatment of learning disorders.

CMC members are very active on local, federal and national levels for political and public promotion of mental health issues, for patients and representative, in societies, federations, political committees, boards, etc. to continuously and vigorously fight stigma, raise awareness and advocate mental health.

Public Outreach, stakeholders: The members of CMC are highly aware of their social responsibility to deliver their scientific insights to a broad audience. To make the general public aware of important mental health topics, we ensure that these are distributed through national newspapers, online news platforms (e.g. Spectrum.de), television (e.g. award winning children´s programmes, or popular science TV-programs; ZDFinfo Doku) and various social media channels (e.g. youtube1, youtube2, DIPF-blog, health blog, tweets).

There are board-certified training centres for adult, child and adolescent psychotherapists at the universities of GI, MR, and FR. Numerous networks exist with lively exchange of interdisciplinary teams (e.g. physicians network PriMa, psychotherapy network PSYMA, Pain Network) and counselling centres (MainKind, outpatient-clinic, trauma network).

Our CMC clinical network will be broadened to all 25 Vitos Psychiatric Hospitals (former Hesse state hospitals), intensified with practitioner networks (e.g., PSYMA, PriMa) and to all Asklepios company hospitals for Psychiatry, Child Psychiatry and Psychosomatics. The UKGM is part of the Rhön company, which is part of Asklepios. This is the largest German private hospital company (150 healthcare facilities, 46.000 employees, 26.000 beds), operating 43 Psychiatric, Child Psychiatry and Psychosomatic Hospitals. Asklepios is therefore one of the largest psychiatric hospital operators in Germany. This puts the CMC in the unique position to access a huge number of hospitals/patients/health care providers for studies and for easy transfer of the DZP research findings into practice across Germany.