Centre Hospitalier Henri Laborit

BackgroundWhile recovery orientation is national policy in many countries, evidence remains limited for the effectiveness at a service level. This paper describes the protocol for implementing a pro-recovery training intervention (REFOCUS-RETAFORM) in specialist mental health services across France. The aim is to evaluate whether REFOCUS-RETAFORM plus usual care leads to improved outcomes for adolescent and adult mental health service users compared with usual care alone.MethodsA two-step stepped wedge cluster randomised controlled trial will be conducted, with a nested qualitative sub-study exploring stakeholders’ views on changes in staff-user relationships and implementation influences. The REFOCUS-RETAFORM intervention is a training intervention for mental health staff, to develop recovery-promoting relationships and pro-recovery working practices. Clusters are services, which transition sequentially from control to intervention condition in a randomised order. Eight clusters are randomised to deliver REFOCUS-RETAFORM in year one and eight clusters in year two. Each cluster delivers REFOCUS-RETAFORM to two teams from their organisation (32 teams in total). Participants are a) service users aged 13–65 years attending services implementing REFOCUS-RETAFORM, and b) staff receiving the intervention. The primary outcome is the Questionnaire about the Process of Recovery. Secondary outcomes include perceived stigma and coercion, self-stigma and wellbeing for service users, and recovery-orientation for staff. Data will be collected from 540 service users (180 at baseline, 180 at month 12, 180 at month 24) and 220 staff. We will use multilevel mixed-effects models, adjusting for secular trends and thematic analysis for the qualitative interview data.DiscussionFindings will inform the continued transformation of French specialist mental health services toward a recovery orientation.Trial registrationClinical Trials NCT05824234, registered 21 April 2023.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12888-025-07253-w.

IntroductionThe physiopathology of patients with treatment-resistant obsessive-compulsive disorder (OCD) may differ from that of treatment-responsive patients. Cognitive evoked potentials may be one of the ways to detect these differences. The error-related negativity (ERN) is an electrophysiological correlate of error detection during the execution of a motor task, which is larger in patients with OCD than in typical people. According to the literature, the ERN could vary according the patients’ treatment-resistance.ObjectivesThe main goal of this study was to assess whether the ERN, which begins 20 ms before the motor response and reaches its maximum 80 ms later, was different between non-resistant and highly resistant OCD patients.MethodsForty-seven OCD patients and their age- and gender-matched controls were asked to perform a flanker task while the potentials evoked by their motor responses were recorded. For each participant, the difficulty of the task was adjusted to get an error rate of about 20%. Treatment-resistance was evaluated using Pallanti and Quercioli’s (Prog Neuropsychopharmacol Biol Psychiatry 2006; 30 400-412) resistance scales.ResultsIn all participants, response errors evoked an ERN at fronto-central electrodes [Fz, FCz, red and green lines on the figure], whereas the negativity was absent or smaller for correct responses (black and blue lines on the figure, both ps < .01). As expected, the ERN of OCD patients was consistently larger and of longer duration than that of control participants (compare the green and blue lines with the red and black ones, respectively). Interestingly, the amplitude of the potentials evoked by correct responses at central and centro-parietal electrodes on the left side of the brain [C5, C3, CP5] was significantly less negative in treatment-resistant patients (all ps < .05). In control participants, the ERN recorded at fronto-central electrodes were followed by a positive wave which reached its maximum between 170 and 270 ms after the response, and was larger after errors than after correct response. In OCD patients in contrast, this positive wave was absent whether the response was correct or not.Image:ConclusionsThe significant correlation observed between OCD patients’ treatment resistance and the potential evoked by correct responses on the left side of the brain suggest that this potential could be used as a marker of treatment-resistance. The absence in OCD patients of the positive wave that follows the ERN in control participants suggests that OCD patients were not fully aware of whether or not their response was correct.Disclosure of InterestNone Declared

ABSTRACT Failure increases the motivation to escape self-awareness. To date, however, the role of self-conscious emotions (shame and guilt) in triggering escape responses after failure has not been sufficiently addressed. In this pre-registered study (N = 156 undergraduates), we adapted a classic paradigm (avoidance of one’s image in a mirror) to a modern eye-tracking technology to test the hypothesis that shame proneness moderates the effect of failure on self-awareness avoidance. Individual differences in guilt and shame proneness were assessed before priming thoughts of failure or success. Then, an eye-tracking paradigm was used to monitor gaze avoidance of one’s screen-reflected face during a neutral, unrelated task. Unexpectedly, results showed that guilt but not shame proneness exacerbated self-avoidance after failure. The present findings challenge the dominant view that shame fosters avoidance more so than guilt.