Brief Educational Workshops in Secondary Schools Trial (BESST trial), a school-based cluster randomised controlled trial of the DISCOVER workshop for 16-18-year-olds: recruitment and baseline characteristics.

BACKGROUND: The Brief Educational Workshops in Secondary Schools Trial (BESST) is an England-wide school-based cluster randomised controlled trial assessing the clinical and cost-effectiveness of an open-access psychological workshop programme (DISCOVER) for 16-18-year-olds. This baseline paper describes the self-referral and other recruitment processes used in this study and the baseline characteristics of the enrolled schools and participants. METHOD: We enrolled 900 participants from 57 Secondary schools across England from 4th October 2021 to 10th November 2022. Schools were randomised to receive either the DISCOVER day-long Stress workshop or treatment as usual which included signposting information. Participants will be followed up for 6 months with outcome data collection at baseline, 3-month, and 6-month post randomisation. RESULTS: Schools were recruited from a geographically and ethnically diverse sample across England. To reduce stigma, students were invited to self-refer into the study if they wanted help for stress. Their mean age was 17.2 (SD = 0.6), 641 (71%) were female and 411 (45.6%) were from ethnic minority groups. The general wellbeing of our sample measured using the Mood and Feelings Questionnaire (MFQ) found 314 (35%) of students exhibited symptoms of depression at baseline. Eighty percent of students reported low wellbeing on the Warwick Edinburgh Mental Wellbeing Scale (WEMWBS) suggesting that although the overall sample mean is below the cut-off for depression, the self-referral approach used in this study supports distressed students in coming forward. CONCLUSION: The BESST study will continue to follow up participants to collect outcome data and results will be analysed once all the data have been collected. TRIAL REGISTRATION: ISRCTN registry ISRCTN90912799. Registered on 28 May 2020.

Long-term effects of psychosocial interventions for adolescents on depression and anxiety: a systematic review and meta-analysis.

Background: Adolescence represents a distinctive phase of development, and variables linked to this developmental period could affect the efficiency of prevention and treatment for depression and anxiety, as well as the long-term prognosis. The objectives of this study were to investigate the long-term effectiveness of psychosocial interventions for adolescents on depression and anxiety symptoms and to assess the influence of different intervention parameters on the long-term effects. Methods: In this systematic review and meta-analysis, we searched five databases (Cochrane Library, Embase, Medline, PsychInfo, Web of Science) and trial registers for relevant papers published between database inception and Aug 11, 2022, with no restrictions on the language or region in which the study was conducted. An updated search was performed on Oct 3, 2023. Randomised controlled trials of psychosocial interventions targeting specifically adolescents were included if they assessed outcomes at 1-year post-intervention or more. The risk of bias in the results was assessed using the Cochrane RoB 2.0. Between-study heterogeneity was estimated using the I2 statistic. The primary outcome was depression and studies were pooled using a standardised mean difference, with associated 95% confidence interval, p-value and I2. The study protocol was pre-registered on PROSPERO (CRD42022348668). Findings: 57 reports (n = 46,678 participants) were included in the review. Psychosocial interventions led to small reductions in depressive symptoms, with standardised mean difference (SMD) at 1-year of -0.08 (95% CI: -0.20 to -0.03, p = 0.002, I2 = 72%), 18-months SMD = -0.12, 95% CI: -0.22 to -0.01, p = 0.03, I2 = 63%) and 2-years SMD = -0.12 (95% CI: -0.20 to -0.03, p = 0.01, I2 = 68%). Sub-group analyses indicated that targeted interventions produced stronger effects, particularly when delivered by trained mental health professionals (K = 18, SMD = -0.24, 95% CI: -0.38 to -0.10, p = 0.001, I2 = 60%). No effects were detected for anxiety at any assessment. Interpretation: Psychosocial interventions specifically targeting adolescents were shown to have small but positive effects on depression symptoms but not anxiety symptoms, which were sustained up to 2 years. These findings highlight the potential population-level preventive effects if such psychosocial interventions become widely implemented in accessible settings, such as schools. Future trials should include a longer term-follow-up at least at 12 months, in order to determine whether the intervention effects improve, stay the same or wear off over time. Funding: UKRIMedical Research Council.

Engaging Older Adolescent Boys Into School-Based Mental Health Workshops: Testing Theory-Based Facilitators and Barriers in Focus Groups.

Untreated mental health problems continue from childhood and adolescence into adulthood, meaning accessible early intervention is essential to reduce long-term negative outcomes. However, there is often a reluctance to engage in mental health treatment, with considerable evidence that young men are less likely to seek help than young women. This original research study aimed to explore four areas of interest around facilitating engagement of adolescent boys to a stress workshop intervention for adolescents in U.K. schools. The areas explored were male role models, destigmatizing language, trust building, and using a transparent and collaborative approach. We also sought to understand the main barriers to engagement. To explore these areas of interest, two focus groups were run, with a total of 12 young men, over two regional sites (London and Bath). Content analysis was used to analyze the data. Participants particularly valued transparency and collaboration as strong facilitators to engagement. Building of trust was the next most popular. Use of role models and destigmatizing language were the joint third most popular methods. The main barrier to help-seeking identified was perceived threat to masculine identity (self and social stigma). Given these novel findings, the factors of transparency and collaboration and building trust as facilitators merit further research, among both adults and adolescents.

Brief Educational Workshops in Secondary Schools Trial (BESST): protocol for a school-based cluster randomised controlled trial of open-access psychological workshop programme for 16-18-year-olds.

Anxiety and depression are increasingly prevalent in adolescents, often causing daily distress and negative long-term outcomes. Despite the significant and growing burden, less than 25% of those with probable diagnosis of anxiety and depression are receiving help in England. Significant barriers to help-seeking exist in this population, with a scarcity of easily accessible, effective, and cost-effective interventions tailored specially for this age group. One intervention that has been shown to be feasible to deliver and with the promise of reducing stress in this age group is a school-based stress workshop programme for 16-18-year-olds (herein called DISCOVER). The next step is to rigorously assess the effectiveness, and cost-effectiveness, of the DISCOVER intervention in a fully powered cluster randomised controlled trial (cRCT). If found to be clinically and cost-effective, DISCOVER could be scaled up as a service model UK-wide and have a meaningful impact on the mental health of adolescents across the country.Trial registration: ISRCTN registry ISRCTN90912799. Registered with ISRCTN 28 May 2020.

How Can We Actually Change Help-Seeking Behaviour for Mental Health Problems among the General Public? Development of the 'PLACES' Model.

Good treatment uptake is essential for clinically effective interventions to be fully utilised. Numerous studies have examined barriers to help-seeking for mental health treatment and to a lesser extent, facilitators. However, much of the current research focuses on changing help-seeking attitudes, which often do not lead to changes in behaviour. There is a clear gap in the literature for interventions that successfully change help-seeking behaviour among the general public. This gap is particularly relevant for early intervention. Here we describe the development of a new model which combines facilitators to treatment and an engaging, acceptable intervention for the general public. It is called the 'PLACES' (Publicity, Lay, Acceptable, Convenient, Effective, Self-referral) model of treatment engagement. It is based on theoretical work, as well as empirical research on a low intensity psychoeducational cognitive behavioural therapy (CBT) intervention: one-day workshops for stress and depression. In this paper, we describe the development of the model and the results of its use among four different clinical groups (adults experiencing stress, adults experiencing depression, adolescents (age 16-18) experiencing stress, and mothers with postnatal depression). We recorded high rates of uptake by people who have previously not sought help and by racial and ethnic minority groups across all four of these clinical groups. The clinical and research implications and applications of this model are discussed.

Training negative connectivity patterns between the dorsolateral prefrontal cortex and amygdala through fMRI-based neurofeedback to target adolescent socially-avoidant behaviour.

Social anxiety is prevalent in adolescence. Given its role in maintaining fears, reducing social avoidance through cognitive reappraisal may help attenuate social anxiety. We used fMRI-based neurofeedback (NF) to increase 'adaptive' patterns of negative connectivity between the dorsolateral prefrontal cortex (DLPFC) and the amygdala to change reappraisal ability, and alter social avoidance and approach behaviours in adolescents. Twenty-seven female participants aged 13-17 years with varying social anxiety levels completed a fMRI-based NF training task where they practiced cognitive reappraisal strategies, whilst receiving real-time feedback of DLPFC-amygdala connectivity. All participants completed measures of cognitive reappraisal and social approach-avoidance behaviour before and after NF training. Avoidance of happy faces was associated with greater social anxiety pre-training. Participants who were unable to acquire a more negative pattern of connectivity through NF training displayed significantly greater avoidance of happy faces at post-training compared to pre-training. These 'maladaptive' participants also reported significant decreases in re-appraisal ability from pre to post-training. In contrast, those who were able to acquire a more 'adaptive' connectivity pattern did not show these changes in social avoidance and re-appraisal. Future research could consider using strategies to improve the capacity of NF training to boost youth social-approach behaviour.

Modulatory effects of dynamic fMRI-based neurofeedback on emotion regulation networks in adolescent females.

Research has shown that difficulties with emotion regulation abilities in childhood and adolescence increase the risk for developing symptoms of mental disorders, e.g anxiety. We investigated whether functional magnetic resonance imaging (fMRI)-based neurofeedback (NF) can modulate brain networks supporting emotion regulation abilities in adolescent females. We performed three experiments (Experiment 1: N â€‹= â€‹18; Experiment 2: N â€‹= â€‹30; Experiment 3: N â€‹= â€‹20). We first compared different NF implementations regarding their effectiveness of modulating prefrontal cortex (PFC)-amygdala functional connectivity (fc). Further we assessed the effects of fc-NF on neural measures, emotional/metacognitive measures and their associations. Finally, we probed the mechanism underlying fc-NF by examining concentrations of inhibitory and excitatory neurotransmitters. Results showed that NF implementations differentially modulate PFC-amygdala fc. Using the most effective NF implementation we observed important relationships between neural and emotional/metacognitive measures, such as practice-related change in fc was related with change in thought control ability. Further, we found that the relationship between state anxiety prior to the MRI session and the effect of fc-NF was moderated by GABA concentrations in the PFC and anterior cingulate cortex. To conclude, we were able to show that fc-NF can be used in adolescent females to shape neural and emotional/metacognitive measures underlying emotion regulation. We further show that neurotransmitter concentrations moderate fc-NF-effects.

Systematic Review and Meta-Analysis: Eye-Tracking of Attention to Threat in Child and Adolescent Anxiety.

OBJECTIVE: Attention biases for threat may reflect an early risk marker for anxiety disorders. Yet questions remain regarding the direction and time-course of anxiety-linked biased attention patterns in youth. A meta-analysis of eye-tracking studies of biased attention for threat was used to compare the presence of an initial vigilance toward threat and a subsequent avoidance in anxious and nonanxious youths. METHOD: PubMed, PsycARTICLES, Medline, PsychINFO, and Embase were searched using anxiety, children and adolescent, and eye-tracking-related key terms. Study inclusion criteria were as follows: studies including participants ≤18 years of age; reported anxiety using standardized measures; measured attention bias using eye tracking with a free-viewing task; comparison of attention toward threatening and neutral stimuli; and available data to allow effect size computation for at least one relevant measure. A random effects model estimated between- and within-group effects of first fixations toward threat and overall dwell time on threat. RESULTS: Thirteen eligible studies involving 798 participants showed that neither youths with or without anxiety showed significant bias in first fixation to threat versus neutral stimuli. However anxious youths showed significantly less overall dwell time on threat versus neutral stimuli than nonanxious controls (g = -0.26). CONCLUSION: Contrasting with adult eye-tracking data and child and adolescent data from reaction time indices of attention biases to threat, there was no vigilance bias toward threat in anxious youths. Instead, anxious youths were more avoidant of threat across the time course of stimulus viewing. Developmental differences in brain circuits contributing to attention deployment to emotional stimuli and their relationship with anxiety are discussed.

Associations Between Attentional Bias and Interpretation Bias and Change in School Concerns and Anxiety Symptoms During the Transition from Primary to Secondary School.

The transition from primary to secondary school is often associated with a period of heightened anxiety and worry. For most children, any feelings of anxiety subside relatively quickly but for a small minority, emotional difficulties can continue into the first year of secondary school and beyond. This study recruited 109 children and measured their anxiety symptoms and school concerns toward the end of primary school and again at the end of their first term of secondary school. We investigated for the first time whether pre-transition measures of attentional and interpretation bias, and the magnitude of change in attentional bias toward and away from threat stimuli were associated with pre- and post-transition measures of anxiety and school concerns, and the change in these measures over time. Over 50% of the current sample exceeded clinical levels of anxiety at pre-transition. However, anxiety symptoms and school concerns had significantly reduced by post-transition. Higher levels of pre-transition anxiety or school concerns, and a greater magnitude of change in attentional bias towards threat stimuli predicted a larger reduction in anxiety symptoms and school concerns across the transition period. A greater interpretation bias toward threat was associated with higher pre-transition anxiety symptoms and school concerns but not post-transition scores, or the change in these scores. While many children experience heightened anxiety prior to school transition, this appears to be largely temporary and self-resolves. Nonetheless, the current findings highlight the importance of monitoring children's anxiety and concerns, and related cognitive processes during this important transition period.

Greater Response Interference to Pain Faces Under Low Perceptual Load Conditions in Adolescents With Impairing Pain: A Role for Poor Attention Control Mechanisms in Pain Disability?

Persistent pain in young people in the community is common, but individuals vary in how much pain impacts daily life. Information-processing accounts of chronic pain partly attribute the fear and avoidance of pain, as well as associated interference, to a set of involuntary biases, including the preferential allocation of attention resources toward potential threats. Far less research has focused on the role of voluntary goal-directed attention control processes, the ability to flexibly direct attention toward and away from threats, in explaining pain-associated interference. Using a visual search task, we explored a poor attention control account of pain interference in young people with persistent pain from the community. One hundred and forty five young people aged 16 to 19 years were categorized into three groups: non-chronic pain (n = 68), low-interfering persistent pain (n = 40), and moderate- to high-interfering persistent pain (n = 22). We found that only adolescents with moderate-to high-interfering persistent pain but not the other two groups of adolescents were affected by a search task preceded by a pain face (compared to a neutral face), but this within-group difference emerged only under low perceptual load conditions. Because low perceptual load conditions are thought to require more strategic attention resources to suppress the interfering effects of pain face primes, our findings are consistent with a poor attention control account of pain interference in young people. Analyses further showed that these differences in task performance were not explained by confounding effects of anxiety. If replicated, these findings may have implications for understanding and managing the pain-associated disability in adolescents with chronic pain. PERSPECTIVE: Young people with moderately and highly interfering pain responded slower on an easy search task after seeing a pain face than after seeing a neutral face. If replicated, these findings could mean that boosting the ability to control attention toward and away from threatening cues is an effective strategy for managing interference from pain.

Multisession Cognitive Bias Modification Targeting Multiple Biases in Adolescents with Elevated Social Anxiety.

Research studies applying cognitive bias modification of attention (CBM-A) and interpretations (CBM-I) training to reduce adolescent anxiety by targeting associated cognitive biases have found mixed results. This study presents a new multi-session, combined bias CBM package, which uses a mix of training techniques and stimuli to enhance user-engagement. We present preliminary data on its viability, acceptability and effectiveness on reducing symptoms and biases using an A-B case series design. 19 adolescents with elevated social anxiety reported on their social anxiety, real-life social behaviours, general anxiety, depression, and cognitive biases at pre/post time-points during a 2-week baseline phase and a 2-week intervention phase. Retention rate was high. Adolescents also reported finding the CBM training helpful, particularly CBM-I. Greater reductions in social anxiety, negative social behaviour, and general anxiety and depression, characterised the intervention but not baseline phase. There was a significant correlation between interpretation bias change and social anxiety symptom change. Our enhanced multi-session CBM programme delivered in a school-setting appeared viable and acceptable. Training-associated improvements in social anxiety will require further verification in a study with an active control condition/group.

The effects of verbal information and approach-avoidance training on children's fear-related responses.

BACKGROUND AND OBJECTIVES: This study examined the effects of verbal information and approach-avoidance training on fear-related cognitive and behavioural responses about novel animals. METHODS: One hundred and sixty children (7-11 years) were randomly allocated to receive: a) positive verbal information about one novel animal and threat information about a second novel animal (verbal information condition); b) approach-avoidance training in which they repeatedly pushed away (avoid) or pulled closer (approach) pictures of the animals (approach-avoidance training), c) a combined condition in which verbal information was given prior to approach-avoidance training (verbal information + approach-avoidance training) and d) a combined condition in which approach-avoidance training was given prior to verbal information (approach-avoidance training + verbal information). RESULTS: Threat and positive information significantly increased and decreased fear beliefs and avoidance behaviour respectively. Approach-avoidance training was successful in training the desired behavioural responses but had limited effects on fear-related responses. Verbal information and both combined conditions resulted in significantly larger effects than approach-avoidance training. We found no evidence for an additive effect of these pathways. LIMITATIONS: This study used a non-clinical sample and focused on novel animals rather than animals about which children already had experience or established fears. The study also compared positive information/approach with threat information/avoid training, limiting specific conclusions regarding the independent effects of these conditions. CONCLUSIONS: The present study finds little evidence in support of a possible causal role for behavioural response training in the aetiology of childhood fear. However, the provision of verbal information appears to be an important pathway involved in the aetiology of childhood fear.

Eluding the illusion? Schizophrenia, dopamine and the McGurk effect.

Perceptions are inherently probabilistic; and can be potentially manipulated to induce illusory experience by the presentation of ambiguous or improbable evidence under selective (spatio-temporal) constraints. Accordingly, perception of the McGurk effect, by which individuals misperceive specific incongruent visual and auditory vocal cues, rests upon effective probabilistic inference. Here, we report findings from a behavioral investigation of illusory perception and related metacognitive evaluation during audiovisual integration, conducted in individuals with schizophrenia (n = 30) and control subjects (n = 24) matched in terms of age, sex, handedness and parental occupation. Controls additionally performed the task after an oral dose of amisulpride (400 mg). Individuals with schizophrenia were observed to exhibit illusory perception less frequently than controls, despite non-significant differences in perceptual performance during control conditions. Furthermore, older individuals with schizophrenia exhibited reduced rates of illusory perception. Subsequent analysis revealed a robust inverse relationship between illness chronicity and the illusory perception rate in this group. Controls demonstrated non-significant modulation of perception by amisulpride; amisulpride was, however, found to elicit increases in subjective confidence in perceptual performance. Overall, these findings are consistent with the idea that impairments in probabilistic inference are exhibited in schizophrenia and exacerbated by illness chronicity. The latter suggests that associated processes are a potentially worthwhile target for therapeutic intervention.