Psychotic-like experiences in adolescents linked to depression and self-destructive behaviour
Psychotic-like experiences resemble symptoms of psychosis, but are milder, less frequent and much more common than psychotic disorders. While these symptoms do not constitute a disorder diagnosed as psychosis, they can still be disruptive, distressing or detrimental to functional capacity. Typical psychotic-like experiences include perceptual distortions and hallucinations, suspicious paranoid thinking, delusions and bizarre, unusual thoughts.
According to a study recently completed by researchers in adolescent psychiatry at the University of Helsinki and HUS Helsinki University Hospital, psychotic-like experiences are abundant among adolescents referred to care, but are generally considered fairly neutral, with only some of the adolescents reporting them as frightening, worrisome or harmful. In the study, the correlation between psychotic-like experiences and depressive symptoms turned out to be strong. This link was not explained by connections between individual psychotic-like experiences and depressive symptoms, but by factors that more broadly measure paranoia and unusual thoughts. In addition to depressive symptoms, paranoid thoughts and unusual thought content were also associated with self-destructive thinking.
Making questions about psychotic-like experiences part of care
The findings show that psychotic-like experiences should be systematically surveyed in all adolescents seeking psychiatric care. It should also be assessed how frightening, worrisome or harmful they are considered to be. Particularly in the case of responses emphasising bizarre thinking and exaggerated suspiciousness, attention should also be paid to assessing mood and self-destructive thinking, as these factors can remain hidden without further enquiry.
“Our findings provide a clear recommendation for treatment practices: psychotic-like experiences should be assessed as part of routine procedures, but it is also important to determine how they are perceived. These phenomena cannot be uncovered unless separately and systematically asked,” says the principal investigator, Docent Niklas Granö.
It should be clearly explained to adolescents and their families that these symptoms are common and often manageable. In addition, applications of cognitive psychotherapy, even brief interventions, can help adolescents understand their symptoms and alleviate the strain they cause.
“The assessment and treatment of adolescent mental health has been entirely underresourced in Finland. Now, the launch and development of operations by the new wellbeing services counties offers a great opportunity to develop psychiatric care for adolescents and take into consideration the assessment and potential treatment, even in the short term, of common symptoms that are often excluded from systematic assessment,” says Granö.
Related research articles:
Prevalence of psychotic-like experiences and their association with depression symptoms among patients entering adolescent psychiatric care. Granö, Lintula, Therman, Marttunen, Edlund & Ranta. Nordic Journal of Psychiatry, 2024
Journal
Psychosis
Subject of Research
People
Article Title
Under the surface: paranoid and unusual thought content are associated with depressive symptoms and suicidal ideation in adolescents entering psychiatric care
‘Teen-friendly’ mindfulness therapy aims to help combat depression among teenagers
University of Cambridge
Researchers have developed a mindfulness therapy tailored specifically to appeal to teenagers to help them cope with increasing levels of depression and mental health problems.
The approach teaches participants to tune into and manage negative thought patterns that can trigger or maintain depression, and allow them instead to focus on the present moment.
Developed by teams at the University of Cambridge and King’s College London, the ATTEND programme – Adolescents and carers using mindfulness Therapy To END depression – also includes sessions for parents and guardians, ensuring a family-centred approach to tackling the problem. The programme is funded by the National Institute for Health and Care Research.
Depression among teenagers is a serious issue in the UK, affecting approximately 140,000 young people aged 15-19. Only about 35,000 receive treatment, and of these 14,000 do not respond to the treatment while an additional 8,000 relapse after initial success. This highlights an urgent need for more effective and sustainable solutions.
Professor Tamsin Ford, Head of the Department of Psychiatry at the University of Cambridge, said: “Too many young people struggle with their mental health but fail to get the support they need through the NHS. Even among those who do receive support, the treatment doesn’t work effectively enough for more than half of them.
“We know that adult mindfulness courses can help people living with depression, but what might work for an adult is likely to be different from what will work for a teenager. That’s why we’ve developed a more ‘teen-friendly’ therapy that’s more engaging and, we hope, more effective.”
Professor Ford and colleagues from King’s College London and the Universities of Exeter and Surrey have developed Mindfulness for Adolescents and Carers, a programme based on the highly-regarded Mindfulness-Based Cognitive Therapy (MBCT).
MBCT is an evidence-based treatment recommended by the National Institute for Health and Care Excellence (NICE) for adults with recurrent depression. It combines mindfulness techniques with cognitive behavioural approaches to help individuals avoid relapse. Professor Ford and colleagues have been adapting MBCT to make it more engaging and effective for teenagers.
With the new course, teenagers will attend eight weekly skills-based sessions delivered either in person or online in groups. The ATTEND programme is also working with families to design an app that helps participants reinforce the skills they learn between sessions.
Unlike traditional MBCT, Mindfulness for Adolescents and Carers includes sessions for both teens and their parents or carers. There are also more movement breaks, shorter skills practice sessions, snacks, and teen-friendly activities.
Professor Patrick Smith, Professor of Clinical Psychology at King’s College London, said: “Supporting a teenager with depression can be incredibly challenging for families. Parents often struggle to know how to best help their children. That’s why our course offers separate, parallel training for parents or carers alongside the teens’ sessions. We hope this will help parents better understand and support their child’s recovery, while also potentially improving their own mental health and family relationships.”
While MBCT is well-established for adults, its effectiveness for teenagers is still being explored. The ATTEND programme is a large-scale trial across England that aims to assess whether Mindfulness for Adolescents and Carers is more effective than the current NHS treatments available for depression.
The team aims to recruit 480 teenagers and their parents, half of whom will participate in the mindfulness groups, while the other half continue with their usual care. The researchers will be looking at outcomes such as recovery rates, relapse prevention, and cost-effectiveness compared with standard approaches.
Professor Ford added: “Although our main goal is to see whether our mindfulness course can help teenagers recover from low mood or depression and prevent relapses, we’re also interested in the benefits it might provide to their carers.
“Equally importantly, we want to see whether this approach – if effective – could be integrated into NHS services. This would ensure that it’s accessible to many more teenagers who are struggling with their mental health.”
Young people and parents who have experienced depression have been involved in the design of the ATTEND programme from the beginning. Their input has ensured that the programme is tailored to the needs of families and is engaging for both teens and their carers.
How to Get Involved
The ATTEND team is currently recruiting 15- to 18-year-olds experiencing depression or low mood, who have received some treatment but have not fully recovered, to participate in the trial in Cambridge and Peterborough, London, Devon, Sussex, Nottingham, and Oxford. Participants are also offered a financial incentive of £60 each for completing the study.
If you or someone you know is interested in participating, please visit the ATTEND study website for more information.
“If we can get in early, then we can save people future pain”
Kat Nellist knows exactly what it is like to experience anxiety and depression when you’re young. Even by the age of eight years old, she was receiving counselling.
“I couldn’t really remember a time where I didn't have it,” she says.
Kat was very anxious and found it hard to make friends. She struggled to focus on school work and didn’t get involved in school activities. “All those sorts of things, like a sense of achievement and a social circle, if you don't have them in your life, then it's hard to keep yourself going. It makes it worse and worse, because you withdraw from everything, and that makes you even sadder. It was a bad spiral.”
Kat received a formal diagnosis of anxiety and depression in her pre-teens and tried different types of therapies, including cognitive behavioural therapy (CBT), also known as ‘talking therapy’, but struggled to connect with her therapist, an experience not uncommon, she says.
When she was 15, she was offered mindfulness-based cognitive therapy (MBCT). It was an eight-week group-based activity. Group meetings may sound daunting for someone who suffers from anxiety, but she says it meant she was able to meet people similar to herself, which conversely helped reduce her anxiety.
“CBT is about trying to distance yourself from your thoughts and realising that your thoughts don't have to control your feelings,” she says. “It teaches you that you don’t have to interact with your thoughts. It allows you to recognise negative thought patterns when they occur, whether that’s negative ‘self-talk’ or feeling that something small will be the end of the world. You learn to say to yourself, ‘I'm having this thought pattern, but that doesn't mean I have to believe it. It's a thought, it's not a fact.’”
MBCT takes this a step further and teaches the individual to allow the negative thoughts to come and go and to be present in the current moment, for example when enjoying time with friends.
“It teaches you to think ‘Well, that's a really sad thought, but I'd rather attend to the thing I'm busy doing. Because right now, I don't need to get pulled down that little spiral and I can actually continue enjoying my coffee.’”
Importantly, too, the course helped improve Kat’s relationship with her parents. “When you're a teenager, there’s always a bit of friction between you and your mum and dad. That's just what being a teenager is. But [MBCT] improved that relationship, which improved my life in every way.”
Now in her mid-twenties, Kat is studying for a degree in Psychology at Goldsmith’s, University of London. She still has negative thoughts, but has learned to live with them. “I still use the coping mechanisms that I learned as a teenager to cope with struggles I have as an adult. You don’t stop having problems entirely, they’re just very different life problems.”
She is determined that her experience can help others, and as such is the patient and public involvement co-lead for the ATTEND study, which she has helped design.
“My main role is making sure that we consider young people's feelings throughout the project. The whole thing needs to be teenager-centred,” she says.
“Teenagers can often get neglected. There's a lot of help for young children and a lot of help for adults, but sometimes when you’re in your mid-teens you can slip through the cracks a little bit. It's an important time to intervene because that is when a lot of mental health problems start to arise. If we can get in early, then we can save people future pain and give them more support.”
Subject of Research
People
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