| Shrnutí: | <p><strong>Systematic Review of Research Literature (SRL)</strong></p>
<p><em>Secondary School-based, Cognitive-Behavioural Interventions to Enhance Positive Self-Concept in Adolescents At-Risk of Mental Health Difficulties: A Systematic Review of Randomised Controlled Trials</em></p>
<p><strong>Background.</strong> Self-concept is a broadly defined factor which may contribute to, or be impacted by, mental health difficulties. Self-concept is malleable during the period of adolescence, providing opportunity for enhancing positive self-concept, and mitigating the formation and impact of a negative self-concept which may emerge during this period and contribute to poor mental health at a later stage.</p>
<p><strong>Aims.</strong> This review identified and synthesised evidence on the effectiveness of secondary school-based, cognitive-behavioural interventions to enhance self-concept in adolescents at-risk of mental health difficulties.</p>
<p><strong>Methods.</strong> Electronic bibliographic databases including MEDLINE, Embase, PsycINFO, CINAHL were searched. Randomised controlled trials were included if they examined the effectiveness of a secondary school-based intervention that included key elements of cognitive-behavioural therapy and was implemented in selected groups considered to be at-risk for mental health difficulties, or groups with subclinical symptoms where intervention was indicated. Quality of studies was appraised using the Cochrane Risk of Bias tool 2. Findings are summarised in relation to our key research questions and in the context of our quality synthesis.</p>
<p><strong>Results.</strong> We identified 17 studies describing various individual and group-based cognitive-behavioural interventions that have been examined in at-risk secondary school groups. Overall, findings suggest that interventions for adolescents at-risk of anxiety or paranoia do not appear to enhance self-esteem measured as either a primary or secondary outcome, although there is an overall lack of research in these groups. There is some evidence that group and skills-based CBT interventions can enhance self-concept in adolescents at-risk of mental health difficulties because of neurodevelopmental, educational, and social (minority status) factors, although the studies have some risk of bias. There are mixed findings for group and individual CBT on self-concept in adolescents at-risk for depression and limited research on dysfunctional anger.</p>
<p><strong>Conclusion.</strong> Findings described heterogenous at-risk groups and measures of self-concept, and further research clarifying closely related concepts of self is needed, together with theory-driven interventions to improve self-concept in at-risk adolescents in order to improve mental health outcomes.</p>
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<p><strong>Service Improvement Project (SIP)</strong></p>
<p><em>The Importance of Group Engagement for the Experience of a Transdiagnostic Group Intervention: An ACT-based Group Intervention for Young People in CAMHS</em>
</p>This project aimed to understand and improve adolescents’ experience of the DNA-v
group, an Acceptance and Commitment Therapy approach to intervention delivered within a
specified health service. The project followed three phases. In phase 1 routinely collected
qualitative interview data and quantitative service outcome data were analysed using to understand adolescents’ engagement within the group. Findings were used in phase 2 to design service improvement recommendations targeting group engagement with input from adolescents. Recommendations were implemented within a follow-on group and phase 3 used the same design as phase 1 to examine changes in group engagement once recommendations were implemented. Participants were adolescents (aged 13-17) attending the DNA-v groups before (N=19), and after (N=9) recommendations were implemented. Findings suggested small positive changes in mean group alliance scores, and in adolescents’ experiences of engaging within the group following implementation of recommendations. Results were interpreted with caution due to methodological
and theoretical limitations but highlight the importance of group engagement for adolescents’ experiences within similar group interventions.</p>
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<p><strong>Theory-Driven Research Project (TDRP)</strong></p>
<p><em>Self-Cognitions in Adolescent Paranoia: A Causal-Interventionist Test with Young People Attending CAMHS</em></p>
<p><strong>Background.</strong> Self-beliefs contribute to the occurrence of paranoia. The development of self-beliefs is a fundamental developmental task during adolescence. Therefore, self-beliefs may play a particular role in adolescent paranoia. Compassionate imagery may be one route to change self-beliefs, and hence paranoia. Using a proof-of-concept experimental design, with embedded tests of mediation, we set out to test the effects of a brief, compassion-focused imagery intervention and examine the role of negative and positive self-cognitions in the occurrence of state paranoia in adolescents.</p>
<p><strong>Method.</strong> Thirty-four help-seeking adolescents with paranoia (<em>M</em> age=17, 78% female) in the U.K.’s National Health Service were randomly assigned to a single session compassionate-imagery intervention that targets self-cognitions or a time-matched imagery control condition. Assessments of state paranoia, positive and negative self-cognitions were conducted at four timepoints (T1[pre-intervention], T2, T3, T4). Eight 2x4 ANOVAs were conducted to examine changes in these outcomes across the intervention period between groups.</p>
<p><strong>Results.</strong> There were no statistically significant effects of the intervention on our primary and secondary paranoia outcomes when compared to an active control condition. Compared to the control group, we found large, significant effects of the intervention on positive self-cognitions “I can keep going”, “I am worth something” (<em>p</em>=0.004, ηp<sup>2</sup>=0.152; <em>p</em>=0.005, ηp<sup>2</sup>=0.154), but not for negative self-cognitions.</p>
<p><strong>Conclusions.</strong> Our findings showed initial positive, short-term effects of our brief compassionate-imagery intervention for adolescents’ positive thoughts abouts themselves, but not for paranoia. We had insufficient evidence to establish the impact of changing self-cognitions on paranoia. Further research is now required with larger samples examined longitudinally.</p>
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