Overview
Adolescent mental health is currently in crisis, with rising rates of depression and anxiety. Universal school-based interventions such as mindfulness have frequently proved to be ineffective due to their relative complexity and lack of youth engagement. There is a clear need for lower-intensity interventions that distil core active ingredients of these more complex protocols and that are acceptable to young people and deliverable by paraprofessionals. To address this need, this project evaluates One Step Back (OSB), a novel, 5-week preventive intervention focused on the mindfulness skill of psychological decentring – the capacity to monitor internal distress and broaden one's perspective. OSB has demonstrated efficacy in extant trials. The current project focuses on understanding OSB’s mechanisms of action.
The project involves a mechanisms-randomised controlled trial (RCT) (N=100) with at-risk adolescents (aged 13-18), comparing OSB against an active control. We will employ a multi-modal approach to elucidate interoceptive, neurocognitive, and behavioural mechanisms of change. Behavioural assays include script-driven autobiographical imagery and cardiac precision tasks. Using task-based fMRI, we will investigate neural markers of ‘Perception Box’ expansion, specifically targeting Default Mode Network (DMN) activation during perspective broadening and insular cortex activity during interoceptive monitoring. Concurrently, a hierarchical Bayesian agent-centred computational model will be developed to formally represent and simulate these mechanisms alongside broader Perception Box processes.
Primary clinical endpoints include depression severity, wellbeing, and anxiety at 3-month follow-up. Mechanistically, we hypothesise that OSB will enhance interoceptive awareness and cognitive reframing capacities. By identifying exactly how and for whom OSB works, this research aims to facilitate precision mental health.
If successful, OSB will provide a theoretically-transparent, scalable, and efficacious solution for preventing severe mental ill-health in vulnerable youth.