Developing a school-based, transdiagnostic, preventative intervention for adolescent mental health

During adolescence we learn to be more independent and form important new relationships. It is also a time when many sadly develop mental health problems. In the last decade, rates of adolescent mental health problems have risen. We, as a society, have started to be more open about mental health struggles and our responsibility to tackle them. Yet, too often, we wait until someone has developed problems before we act. This needs to change. Mental health problems are distressing and disrupt the lives of those who suffer from them. Our project is all about working together with young people to better understand how we can effectively prevent mental health problems before they emerge.

Much previous research has been too focused on diagnostic labels and paid too little attention to what is under the surface. New research is showing us that two key things are critical for making young people more vulnerable to experiencing mental health difficulties:

- The way that adolescents process emotions - for example some are more likely to see neutral situations as threatening than their peers, others have difficulties in managing or controlling their emotions or reading their bodies' signals about what they are feeling.

- Difficulties in social relationships, particularly with their peer group.

We think that it is important to study both topics together as they are connected in profoundly important ways. Surprisingly researchers in the past have looked at them separately. Yet, how we interpret and manage our emotions influences our social relationships, because they affect how we behave and relate. Likewise, our relationships affect how we interpret control or manage our emotions. This two-way connection between emotion and relationships is at the heart of this study.

We will develop a new school-based intervention to prevent mental health problems in adolescents. Our innovative approach addresses the crucial links between emotions and social relationships. We will bring together two very different but established strategies to support young people, one that focuses on training emotional skills and one that addresses young people's relationships. While each has its advantages, combining them will give young people 'the best of both worlds', providing them with skills in recognising and regulating emotions and helping them understand how their emotions affect their social relationships. But also making it clear how social relationships can impact emotions. While there have been many initiatives to support adolescent mental health in schools, we do not know enough about how these interventions work, i.,e., what are the 'mechanisms' that drive positive change? Our research will also advance our understanding of how emotions and relationships affect each other over time, impacting mental health and well-being.

To develop this new intervention, we will collaborate closely with young people to create engaging training exercises in emotional processing, enriched with social exercises that are relevant for young people's lives, and practiced with peers at school, co-facilitated by young people working alongside an experienced practitioner. Our initial consultation with young people indicated that these areas and this approach are highly relevant to their daily lives.

We are committed to ensuring that new knowledge we gain reaches a wide audience. We will work together with young people and performing artists to develop compelling short films, podcasts and infographics that not only educate people about the science of adolescent mental health, but also gives practical tips for understanding emotions and social relationships for young people, teachers and parents. These will convey the idea that mental health problems are not just a problem within an individual or in their environment. Instead, we want to help people understand how relationships and emotions are deeply interconnected and together are central to well-being.

Objective: to capitalise on advances in experimental psychology, social science and clinical research to develop a novel hybrid preventative intervention for adolescent mental health, that embeds specific emotional training techniques into an adapted group-based Interpersonal Therapy (IPT) programme. This is a longitudinal randomised allocation study, with three assessment points at baseline, post-intervention and 1 year follow-up.

Participants: 540 high risk (top 25% for general psychopathology) young people aged 13-14 (school years 8 & 9) randomised into intervention (N=270) and non-intervention (N=270) arms of the study.

Measures: Mental health, Wellbeing, Emotion processing (experimental tasks and questionnaires assessing negative emotion perception, emotion regulation, and interoception), social relationships (social network measures achieved via peer-nomination, as well as questionnaire measures of family and peer relationships, bullying and loneliness), and key demographics will be measured using standard and well validated instruments.

Process evaluation: Mixed-methods approach to study the acceptability, feasibility and barriers to delivery, including thematic analysis of focus-group interviews with recipients of the intervention and key stakeholders.

Statistical Analyses: Mixed-linear analyses to address whether the intervention leads to improvements in the mental health and well-being. Structural equation modelling to test if the intervention's impact on mental health and wellbeing is mediated by changes in emotional processing and social relationships. Stable trait autoregressive trait and state analyses to test bi-directional relationships between emotional processes, social relationships and mental health vulnerability over time.

Scientific deliverables: Pre-registered scientific protocol, intervention clinical manual, scientific papers, conference presentations, analysis plan & analysis scripts, curated dataset for sharing.