Skills for Wellness

The proposed research will test the acceptability and efficacy of an early preventive intervention for the antecedents to severe mental illness with the following hypotheses:

1. Do young people at risk for severe mental illness accept a cognitive-behavioural intervention that targets early antecedents to severe mental illness? 2. Does a cognitive-behavioural intervention targeting antecedents to severe mental illness reduce the rate of unusual auditory and visual experiences, the loss of previously acquired abilities, anxiety, and unstable mood? 3. Does a cognitive-behavioural intervention focused on antecedents reduce emotional distress in young people at risk for severe mental illness? 4. Is social functioning improved in young people at risk for severe mental illness through antecedent-focused cognitive-behavioural intervention? 5. (Long-term) Does early cognitive-behavioural intervention targeting antecedents reduce the risk of developing severe mental illness?

Design: the investigators are proposing to test a new preventive intervention for antecedent conditions for which most individuals would currently receive no intervention at all. Therefore, the best comparison for the proposed intervention is a group of individuals who do not differ from the intervention group at baseline but who are neither offered a specific intervention nor discouraged from seeking any treatment that they may normally receive. Such a non-intervention comparison group is best achieved using the recently-developed cohort-multiple randomized controlled design (cmRCT; Relton et al., 2010) In a cmRCT, eligible participants are identified within a cohort study, which follows up all participants and measures outcomes of interest. A proportion of eligible participants within the cohort is randomly selected and approached to be offered the intervention of interest, while the other eligible participants in the cohort are not so approached (i.e., controls). All participants continue to be followed up as part of the cohort irrespective of whether they accept the offered intervention or not. This enables a more realistic, fair and complete evaluation of the intervention effects. Those randomly selected to be offered maCBT will be approached, given full information about the planned intervention and asked to provide a separate written consent for the intervention study.

Intervention: Multimodal Antecedent-focussed Cognitive-behavioural Training (maCBT). This integrated model focuses on normalisation of the unusual experiences, their re-appraisal, exploring helpfulness of current coping, and developing a repertoire of strategies to decrease the impact of these experiences on the young person's life. The maCBT follows a manual describing obligatory and optional therapeutic elements, proposed list of modules, outline of a therapeutic session, and the integrated cognitive model. The model and techniques are adapted to an age range of 9 to 17 years, with more visual material and child friendly language options for the younger part of the age range (9-12) and more teen-relevant and interpersonal content options for the older part of the age range (13-17). The intervention will be delivered in 8 to 16 one-hour sessions in an individual format. Sessions will be initially weekly, and then spaced out to once every two weeks in the latter stages of the intervention.

• Severe mental illness (long-term outcome) [Срок оценки: Annual follow-ups over 3, 5, 7 and 10 years]
• Distress associated with unusual experiences [Срок оценки: 4-6 months, 1, 2, 3, and 5 years post intervention]
• Functioning [Срок оценки: 4-6 months, 1, 2, 3, 5 , 7 and 10 years post intervention.]
• psychotic-like experiences [Срок оценки: 4-6 months, 1, 2, 3, and 5 years post intervention]
• basic symptoms [Срок оценки: 4-6 months, 1, 2, 3, and 5 years post intervention]
• Anxiety [Срок оценки: 4-6 months, 1, 2, 3, and 5 years post intervention]
• Affective lability - continuous [Срок оценки: 4-6 months, 1, 2, 3, and 5 years post intervention]
• Affective lability [Срок оценки: 4-6 months, 1, 2, 3, and 5 years post intervention]
• Anxiety - continuous [Срок оценки: 4-6 months, 1, 2, 3, and 5 years post intervention]