Promoting helpful attention and interpretation patterns to reduce anxiety and depression in young people: Weaving scientific data with young peoples’ lived experiences

BACKGROUND: Anxiety and depression are common, disabling and frequently start in youth, underscoring the need for effective, accessible early interventions. Promoting adaptive cognitive patterns could reflect “active ingredients” in the treatment and/or prevention of youth anxiety and depression. Here, we described and compared different therapeutic techniques that equipped young people with a more flexible capacity to use attention and/or promoted a tendency to positive/benign (over threatening/negative) interpretations of uncertain situations. We also consulted young people with lived experiences on how effective these strategies are used in daily life and their views on whether additional techniques could be used to promote resilient cognitive patterns.METHODS: We searched electronic databases (PubMed, PsycINFO, EMBASE, and PsycARTICLES) for studies containing words relating to: intervention; youth; anxiety and/or depression and attention and/or interpretation, and selected studies which sought to reduce self-reported anxiety/depression in youth by explicitly altering attention and/or interpretation patterns. Ten young people with lived experiences of anxiety and depression and from diverse backgrounds were invited to give their views on our findings.RESULTS: Two sets of techniques, each targeting different levels of responding with different strengths and weaknesses were identified. Cognitive bias modification training (CBM) tasks were largely able to alter attention and interpretation biases but the effects of training on clinical symptoms was more mixed. In contrast, guided instructions that teach young people to regulate their attention or to evaluate alternative explanations of personally-salient events, reduced symptoms but there was little experimental data establishing the intervention mechanism. Young people reported on additional strategies that could be targeted to promote adaptive cognitive patterns. DISCUSSION: CBM techniques target clear hypothesised mechanisms but require further co-design with young people to make them more engaging and augment their clinical effects. Guided instructions benefit from being embedded in clinical interventions, but lack empirical data to support their intervention mechanism, underscoring the need for more experimental work. Young peoples’ feedback suggest that combining complimentary techniques within multi-pronged “toolboxes” to develop resilient thinking patterns in youth is empowering.