"Not all psychological treatments work the same for everyone"

Every year, Mental Health Week is a key event to give visibility, reflect, and take action regarding the challenges that still surround mental health in our society. The year 2025 is no exception: from October 6 to 10, in Sant Boi de Llobregat, a program will unfold under the title "5 days, 5 challenges," focusing on areas such as mental health and youth, families, sports, research, and uncertainty. In Spain, 2025 arrives with hopeful progress, but also with major challenges ahead. The Government has approved a budget of 39 million euros to strengthen mental health, within the 229 million allocated to reinforcing both Primary Care and mental health and suicide prevention. To give visibility to World Mental Health Day, we interview Dr. Susana Ochoa, head of the Research Group on Etiopathogenesis and Treatment of Severe Mental Disorders (MERITT) at Institut de Recerca Sant Joan de Déu (IRSJD), together with Dr. Judith Usall, and head of research at the Parc Sanitari Sant Joan de Déu (PSSJD).

What are the goals of the PERMEPSY project?

The main goal of the PERMEPSY project is to personalize psychological treatments aimed at people with psychosis. Although it focuses mainly on people with schizophrenia, it also includes other psychotic disorders.

We start from a psychological treatment that has already proven its effectiveness -Metacognitive Training (MCT)- and what we want is to identify which profiles of people respond better to this treatment and to which specific components or strategies. Based on this information, we design more personalized programs, adapting the tasks and exercises that people must do at home to achieve better results.

How have you managed to transform existing data into a treatment adapted to each person?

The project is divided into two main phases. In the first one, we have worked to identify the variables that can predict the response to psychological treatment. To do this, we have created a group that has carried out systematic reviews of the scientific literature, aiming to determine which factors previous studies indicate as the most relevant. At the same time, we have harmonized more than twenty international databases from researchers who had applied Metacognitive Training in people with psychosis.

With this large data set, we developed predictive models using machine learning techniques, thanks to the support of the team at the Polytechnic University of Catalonia (UPC). The results of this analysis allowed us to create a platform that provides information about which areas a person is most and least likely to improve through Metacognitive Training, allowing us to design a personalized version of it, which we are currently testing in the second phase of the project.

Where are you now in the study?

We are currently in the second phase of the study, specifically in the clinical trial. In this stage, one group of patients randomly receives the classic metacognitive treatment, while another group receives the same treatment but with personalized tasks to do at home, adapted to their response profile.

The study aims to include around 250 patients from different countries -Germany, Spain, France, Poland, and Chile-, and at this point, we have already recruited about half of the participants. If everything goes according to schedule, the clinical trial is expected to end in the summer of 2026.

Looking ahead, we want to take a further step and personalize not only the home tasks but also the psychological treatment itself. This would be a second phase of the project's evolution, aimed at adapting Metacognitive Training more comprehensively to each person's needs.

What role does treatment personalization play in mental health and, specifically, in the case of psychosis?

The PERMEPSY project is the first study that seeks to personalize psychological treatment for psychosis. We know that not all people respond the same way to the same treatment, and that's why it is essential to research how to adapt interventions to each individual's needs and characteristics. This is the key to achieving more effective and lasting results.

To do so, we use a machine learning-based platform that integrates different data from each participant -such as clinical, cognitive, metacognitive, and/or sociodemographic variables-. Based on this information, the system identifies five key variables that help us predict the treatment response:

• The intensity of positive symptoms
• The severity of specific delusions
• The person's level of cognitive insight into their own abilities
• Self-esteem
• The degree of treatment adherence

This analysis allows us to better adjust the type of exercises and strategies proposed for each person, making the treatment much more effective and personalized.

How do you think this research can improve the lives of people with psychosis and their families?

If we manage to tailor psychological treatment to each person's specific needs, the degree of improvement can be much greater. Personalization allows the treatment to focus on the aspects each participant needs to strengthen, whether it is working on their self-esteem, awareness of the illness, or managing delusions.

This not only promotes better clinical outcomes but also improves the quality of life of both the affected person and their family environment, as they have more adapted, effective tools with a real impact on their daily lives.

What are the main challenges that still need to be faced in mental health research?

We could distinguish two levels of mental disorders. On one hand, there are common mental disorders, which tend to be milder -although this term is not entirely accurate, since some can become chronic and very severe. Many of these cases could be prevented with appropriate interventions.

On the other hand, there are severe mental disorders, such as schizophrenia, for which recovery can be worked on and, in some cases, prevention is possible if the right tools are available.

Therefore, I believe there are two major challenges in current mental health research. On the one hand, prevention, since with early intervention, many disorders could be avoided or minimized. And on the other hand, treatment personalization, because each person has different needs and responses, and adjusting interventions to these particularities is key to improving therapeutic effectiveness and the quality of life of affected individuals.

If you had to send a message to society during Mental Health Week, what would it be?

During Mental Health Week, I would like to remind everyone that it is essential to promote the integration and understanding of people who suffer from a mental disorder. It is important that they do not feel afraid or self-stigmatize, but rather feel confident to share their experience and seek help when needed.

At the same time, from the research field, we work so that treatments adapt to each person's needs, making them more effective and accessible. Therefore, the message is clear: if you have a mental health problem, don't isolate yourself; seek help and trust that there are resources and treatments designed for you.