Negative symptoms represent one of the most challenging dimensions of schizophrenia. Unlike positive symptoms such as hallucinations and delusions, which involve the presence of abnormal experiences, negative symptoms involve the absence or diminution of normal functioning. These include avolition, or a reduced drive to initiate and sustain goal-directed activity, anhedonia, or a diminished capacity to experience pleasure, asociality, blunted affect, and poverty of speech. For many patients, these symptoms persist even when antipsychotic medications successfully control hallucinations and delusions, and they are strongly linked to social isolation, unemployment, and reduced quality of life.

The scarcity of effective treatments for negative symptoms has long frustrated clinicians and researchers. Most antipsychotic drugs, which primarily act on dopamine systems to suppress positive symptoms, offer little benefit for motivational and pleasure deficits. Psychosocial approaches such as cognitive behavioral therapy and social skills training can help, but their effects are often modest, and access to trained therapists remains a barrier in many health systems. This treatment gap has made the development of scalable, evidence-based interventions for negative symptoms a major priority in mental health research.

CT-155 was developed as a digital therapeutic, a class of software-based interventions intended to deliver therapeutic benefit through structured engagement, often on a computer or tablet. Digital therapeutics differ from general wellness apps in that they are designed to be evaluated in clinical trials with the same rigor expected of medical treatments, measuring safety and efficacy against defined endpoints. In this trial, the intervention was tested specifically against motivation and pleasure negative symptoms, the domain that most directly shapes a patient’s ability to pursue goals, enjoy daily activities, and maintain social connections.

The randomized clinical trial design is the gold standard for determining whether an intervention produces genuine benefit beyond placebo effects or the natural course of a condition. By randomly assigning participants to receive either the digital therapeutic or a comparator, researchers can isolate the specific contribution of the active intervention. In this study, the trial demonstrated that CT-155 improved motivation and pleasure negative symptoms to a degree the investigators characterized as small to moderate. While such effect sizes may sound modest, in psychiatry they are consistent with the magnitude of benefit typically observed for approved psychosocial interventions and pharmacologic treatments, which underscores the clinical relevance of the finding.

Safety and tolerability are equally critical considerations for any new schizophrenia treatment, particularly because patients often take multiple medications and may be sensitive to side effects. The trial reported that CT-155 was well tolerated and safe, an outcome that is notable for a software-based intervention that does not add pharmacologic burden. Because the therapy works through structured digital engagement rather than drug action on brain chemistry, it can in principle be combined with existing antipsychotic regimens without concerns about drug-drug interactions, supporting its proposed role as an adjunctive therapy rather than a replacement for medication.

The corresponding author of the study is Abhishek Pratap, PhD, of Global Clinical Development Mental Health and Eye Health at Boehringer Ingelheim Pharmaceuticals Inc, indicating that the intervention emerged from an industrial research and development program focused on mental health. The involvement of a major pharmaceutical company reflects a broader trend in which drug developers are expanding into digital and combination approaches, recognizing that software-delivered interventions can address aspects of psychiatric illness that molecules alone have failed to reach.

Perhaps the most consequential implication of the finding is scalability. Traditional psychosocial interventions for schizophrenia require trained clinicians, scheduled sessions, and institutional infrastructure, all of which limit how many patients can be reached. A digital therapeutic, once validated and deployed, can in principle be distributed widely and used with far fewer constraints on clinician time and geography. The authors suggest that CT-155 may represent a scalable, accessible option for improving schizophrenia negative symptoms, a claim that carries significant weight for health systems struggling to meet the demand for mental health care.

At the same time, the small-to-moderate effect size is a reminder that digital therapeutics are not a cure and that real-world performance can differ from trial conditions. Questions about long-term durability of benefit, adherence over months and years of use, and effectiveness across diverse patient populations will shape how such interventions are ultimately integrated into care. Digital interventions also depend on patients engaging with the software, and motivation is precisely the faculty impaired by negative symptoms, a challenge that the design of the therapy must address for sustained benefit.

Nevertheless, the trial marks a meaningful step forward in a field where genuine treatment advances for negative symptoms have been rare. Published in JAMA Network Open, a peer-reviewed journal, the study adds to a growing body of evidence that carefully engineered digital interventions can produce clinically measurable improvements in serious mental illness. For the millions of people worldwide living with schizophrenia, many of whom face persistent motivational and pleasure deficits that medications do not relieve, a safe, well-tolerated, and scalable adjunctive therapy offers a reason for cautious optimism and a signal of where psychiatric treatment may be heading.

Subject of Research: A randomized clinical trial of the digital therapeutic CT-155 for negative symptoms of schizophrenia

Article Title: A digital therapeutic intervention for negative symptoms of schizophrenia

Article References: A digital therapeutic intervention for negative symptoms of schizophrenia. (n.d.). Original publication

Image Credits: AI Generated

DOI: Not provided

Keywords: schizophrenia, negative symptoms, digital therapeutics, CT-155, randomized clinical trial, JAMA Network Open, motivation and pleasure deficits, psychiatry, mental health, Boehringer Ingelheim, adjunctive therapy, avolition

The review arrives at a moment when adolescent social media policy has become one of the most contested arenas in public health law. In the United States, numerous states have passed laws requiring parental consent for minors to create social media accounts or mandating age verification, while several of these measures are being challenged in federal courts on First Amendment grounds. Internationally, countries including Australia have committed to restricting social media access for children below a set age threshold, and the United Kingdom has incorporated child-safety duties for online platforms into statutory frameworks. These policies differ substantially in design, enforcement mechanisms and the specific behaviors they target, which makes the absence of comparative evidence all the more consequential for policymakers deciding which approach to adopt.

Nagata and colleagues set out to map what is actually known about these legislative strategies. Their assessment distinguishes between different categories of policy intervention, including age restrictions and verification requirements, design-based regulations that target features such as infinite scroll and algorithmic recommendation systems, time-limit mandates, parental involvement requirements and disclosure or transparency obligations for platforms. For each category, the researchers asked whether published studies had evaluated the policy’s implementation, its effects on social media use itself, and its downstream effects on adolescent health outcomes such as mental health, sleep, body image and exposure to harmful content.

What they found is a landscape dominated by preliminary and indirect forms of evidence. Observational studies, which track associations between social media use patterns and health outcomes in large cohorts of young people, can suggest why particular regulations might help. For example, research linking heavy nighttime use to sleep deprivation, or linking exposure to appearance-related content to disordered eating risk, provides a plausible rationale for design restrictions and usage limits. Expert-opinion publications, including position statements from professional societies and commentaries from researchers, articulate the theoretical case for intervention and flag potential hazards. But neither type of publication can answer the question that legislators ultimately face: does a specific law, as written and enforced, produce the intended benefits without generating countervailing harms?

The review emphasizes that the gap between policy enthusiasm and policy evidence is not merely academic. Unintended consequences are a realistic possibility for nearly every regulatory strategy under discussion. Age-verification requirements, for instance, may push adolescents toward platforms or services with weaker safety standards, or may compel young users to submit sensitive identity documents to third-party verification companies, creating new privacy risks. Blanket bans may sever the social connections, peer support networks and access to information that many adolescents, particularly those from marginalized communities, derive from online spaces. Parental consent requirements may be least effective for the young people considered most vulnerable, including those in unsupportive home environments. Without systematic evaluation, regulators cannot know whether such trade-offs outweigh the benefits a law was designed to deliver.

The authors argue that closing this gap will require rapid research, including timely evaluation of newly enacted legislation as it takes effect. Natural experiments are already unfolding. When a jurisdiction implements an age restriction or a design mandate, researchers have a rare opportunity to measure changes in adolescent behavior, platform engagement and health indicators against comparison populations not yet subject to the rule. Such evaluations, the review suggests, should be built into the legislative process itself rather than conducted years later, so that findings can inform revisions while policies are still being refined. The speed of technological change means that evidence generated slowly may be obsolete by the time it arrives.

Central to the paper’s argument is the idea that policy development should be iterative and collaborative, grounded in theory and centered on the needs of children. Rather than treating legislation as a one-time intervention, the authors envision a cycle in which policies are implemented, rigorously evaluated, and then adjusted based on what the data show. This approach mirrors how other areas of pediatric public health, from vaccination campaigns to traffic safety regulation, have historically progressed: through repeated cycles of intervention, measurement and refinement. A child-centered framework, the authors suggest, would prioritize measurable outcomes for young people themselves, including mental health, developmental wellbeing and safety, rather than focusing solely on compliance metrics such as the number of accounts blocked.

The review also implicitly raises questions about how evidence should weigh in when the underlying science of social media harm is itself contested. Large cohort studies have produced mixed findings on the magnitude of the association between social media use and adolescent mental health, with some analyses suggesting small average effects and others identifying vulnerable subgroups for whom risks appear substantially larger. This heterogeneity complicates the policy calculus. A law calibrated to protect a small high-risk group may impose costs on the much larger population of adolescents for whom social media is neutral or even beneficial. The authors’ call for theory-driven policy reflects an effort to move beyond this impasse, encouraging legislators to specify the mechanisms a law is meant to target so that evaluations can test those mechanisms directly.

For the research community, the paper functions as both a warning and a roadmap. The warning is that the current wave of adolescent social media legislation is proceeding largely without the evaluative infrastructure that has guided other public health interventions, leaving policymakers to act on plausible reasoning rather than demonstrated results. The roadmap is a concrete agenda: evaluate laws as they are enacted, measure both intended benefits and unintended harms, compare different regulatory designs across jurisdictions, and feed those findings back into policy revision. The authors note that observational and expert-opinion literature has value as a starting point, but that systematic evidence must now follow if legislation is to serve the children it is meant to protect.

As more jurisdictions prepare to implement restrictions on adolescent social media use in the coming years, the window for generating high-quality evidence is open now. The review’s message to researchers, funders and policymakers alike is that the era of legislating on preliminary insights alone should give way to an era of evidence-informed iteration, in which every new law doubles as a carefully studied experiment in protecting young people online.

Subject of Research: Evidence evaluating legislative strategies to regulate adolescent social media use

Article Title: Evidence for social media legislation strategies

Article References: Evidence for social media legislation strategies. (n.d.). Original publication

Image Credits: AI Generated

DOI: Not provided

Keywords: adolescent health, social media legislation, age verification, JAMA Network Open, policy evaluation, digital wellbeing, mental health, online safety, unintended consequences, evidence gap, child-centered policy, public health law

The 988 Suicide and Crisis Lifeline was designed to solve a fundamental access problem. Before its launch, people experiencing a mental health crisis had to navigate a ten-digit hotline number, and capacity varied widely. The three-digit dialing code allows anyone in the country to call, text, or chat with trained counselors through a single, easy-to-remember number. When people contact 988, they are routed to local crisis call centers, and those centers depend heavily on funding from individual states. How states raise that money has become one of the central policy questions surrounding the lifeline’s long-term sustainability, because the federal government established the number but left most of the financing responsibility to the states themselves.

Most states finance 988 and related crisis services through their general budget appropriations, the ordinary pool of tax revenue that legislators allocate each year. But twelve states have taken a different approach, creating dedicated telecom fees modeled on the mechanism that has long paid for 911 emergency services in many states. These fees are deliberately small and flat, for example thirty cents per cell phone line per month, spread across millions of subscribers. The study’s lead author, Jonathan Purtle, professor of public health policy and management at NYU School of Global Public Health, noted that mental health advocates have recommended telecom fees to fund 988, but until now it has not been fully understood whether they are making a difference. The answer, he said, is empirically yes, because states that have these telecom fees put more money toward funding suicide prevention.

To reach that conclusion, the research team examined annual state budgets, which may include both state and federal funds, for all fifty states and Washington, DC, across six fiscal years from 2021 through 2026. The researchers looked at what each state allocated specifically for suicide prevention and mental health crisis services, and then analyzed whether those allocations varied according to a range of state-level factors, including geography, budget structure, and the presence of a dedicated fee. This budget-based approach is methodologically demanding because states organize their finances in very different ways, and the authors are careful to acknowledge the limits of comparing line items across fifty-one distinct budgeting systems.

The headline finding is a clear upward trend. Average state spending on suicide prevention and crisis services rose from $1.05 per resident in 2021 to $6.55 per resident in 2025, more than a sixfold increase in per-capita investment in just four years. The proportion of states’ annual budgets devoted to suicide prevention likewise increased, from 0.022 percent of overall spending to 0.079 percent. Those percentages may look tiny, but they represent a meaningful shift in how state governments prioritize crisis response, and they coincide with the period during which 988 launched and public and policymaker attention to mental health crises intensified nationwide.

The regional patterns in the data are striking. Spending was highest in Western states, which invested an average of $7.19 per person per year, followed by the Northeast at $3.44, the South at $2.12, and the Midwest at $2.07. That means residents of the average Western state enjoyed roughly three and a half times the crisis-service investment of residents of the average Midwestern state. Even more consequential for policy debates, the researchers found that spending was twice as large in states that had enacted telecom fees compared with states that relied on other mechanisms. Purtle observed that this finding suggests telecom fees are a promising strategy to enhance crisis service infrastructure, giving legislators who are weighing such fees concrete evidence that the mechanism is associated with substantially higher investment.

One of the study’s more sobering findings concerns the relationship between need and spending. The researchers examined whether states with higher suicide rates are spending more money on suicide prevention and found that this was not necessarily the case. In other words, the states where the problem is most acute are not automatically the states investing the most in response. That mismatch matters because suicide risk is not evenly distributed across the population. Veterans, for example, die by suicide at more than double the rate of nonveterans, and the Department of Veterans Affairs spends $177 per veteran per year on suicide prevention, a figure that underscores just how modest state-level investments remain even after five years of growth.

The authors are careful about the caveats that surround their estimates. Because each state structures its budget differently, and not every state has specific line items or fees for suicide prevention, the classification process is conservative. If a state budgeted for broader mental health programs but did not specify how much of that funding would support suicide prevention and crisis services, the researchers did not count that state as funding suicide prevention that year. Purtle acknowledged that as a result, the study’s findings are likely an underestimate of what states actually spend. For readers, that means the true investment picture may be somewhat brighter than the headline numbers suggest, but it also means the study measures only explicit, designated commitments, which is precisely what advocates say is needed to guarantee stable crisis-line capacity.

The research arrives at a moment when early evidence suggests the 988 system may be having an effect. Emerging research is beginning to show a decline in suicide rates since the launch of 988, although that work has not yet explored whether the decline varies among states, which would be the crucial test of whether state-level funding decisions translate into lives saved. Purtle’s ongoing research program aims to answer exactly that question, examining whether state-level funding for 988 actually reduces suicide deaths and, in particular, whether telecom fees move the needle as a policy solution. If subsequent studies confirm that fee-financed states see larger declines, the twelve states with fees could become models for the rest of the country.

The study was conducted by a team spanning several leading institutions. In addition to Purtle, the authors include Michal Weiss and Jennifer Pomeranz of NYU School of Global Public Health, Ryan McBain and Jonathan Cantor of RAND, and Sachini Bandara, Fernanda Montoya, and Elizabeth Stuart of the Johns Hopkins Bloomberg School of Public Health. The research was funded by the National Institute of Mental Health under grant R01 MH131649, and the authors note that the content is solely their responsibility and does not necessarily represent the official views of the National Institutes of Health. For the growing community of crisis-center operators, state legislators, and advocates watching 988’s development, the study’s message is twofold: state investment in suicide prevention is rising faster than at any point in recent memory, but dedicated, fee-based financing mechanisms appear to be the most reliable way to turn that momentum into durable, well-funded crisis infrastructure that reaches everyone who dials three digits in their darkest moment.

Subject of Research: State-level budget allocations for suicide prevention and 988 crisis services in the United States, including the role of dedicated telecommunications fees

Article Title: State funding for suicide prevention has increased in recent years

Article References: State funding for suicide prevention has increased in recent years. (n.d.). Original publication

Image Credits: AI Generated

DOI: Not provided

Keywords: suicide prevention, 988 lifeline, state budgets, mental health crisis services, telecom fees, health policy, JAMA Network Open, NYU, public health funding, crisis intervention, state government spending, veterans suicide risk