Previous studies have shown that certain groups of young adults appear to be at increased risk for serious psychiatric illness. For example, in young adults, having mild-to-moderate symptoms of depression broadly increases the risk for developing psychiatric illness later on. In addition, mild subclinical psychotic or psychotic-like symptoms, sometimes called “psychotic experiences” are associated with an increase in risk for serious mental illnesses, with previous studies documenting an up to 15-fold increase in risk. This risk is highest if these experiences are distressing or persistent.
Depressive symptoms and psychotic experiences often increase in severity in response to life stressors and other environmental risk factors, including cannabis use, urban living, and discrimination. Previous studies have suggested that interventions in at-risk populations during early or premorbid illness stages may reduce the risk of developing psychiatric illness. Because individuals with these subclinical symptoms typically demonstrate a vulnerability to the effects of stress, researchers have focused on interventions that enhance the ability of at-risk youth to withstand or adapt to the stressors of daily life, as well as more significant adversity.
Researchers from the Resilience and Prevention Program at Mass General, including Anne Burke, PhD, Nicole DeTore, PhD, Maren Nyer, PhD, and Daphne Holt, MD PhD, have developed and piloted an intervention, called Resilience Training (RT), for at-risk youth.
Resilience Training for At-Risk Youth
While it may be possible, in some cases, to limit exposure to some stressful life events, interventions that target how an individual responds to and copes with environmental stressors may be helpful for reducing risk for psychiatric illness in at-risk youth. Studies have shown that levels of emotional ‘resilience’, defined as the ability to adapt to or recover from stressful events, can be increased by learning certain habits of thinking or emotion regulation skills.
Focusing on young adults with subthreshold symptoms of psychiatric illness, including mild or subclinical symptoms of depression, anxiety, and psychotic experiences, researchers from the Resilience and Prevention Program have designed a group-based behavioral intervention for young adults that focuses on teaching emotion recognition skills and strategies for managing distressing thoughts and emotions (Burke et al, 2020).
The Resiliency Training or RT program is a 4-session, group-based behavioral intervention for young adults (aged 18-25 years), primarily college students, and teaches evidence-based skills (mindfulness, self-compassion, mentalization) through didactic material, experiential exercises, and group discussions.
RT consists of four weekly 1.5-h group sessions, co-led by two facilitators, Briefly, RT begins by introducing the concept of resilience and that it can be modified (Session 1). It then focuses on teaching resilience-enhancing skills via didactic and experiential materials adapted from established mindfulness (Session 1), self-compassion (Session 2), and mentalization (Session 3) interventions and how these concepts and skills can be applied in daily life (Session 4).
Randomized Controlled Trial of Resilience Training in College Students
In a randomized, waitlist-controlled trial (DeTore et al, 2023), the research team recruited Boston-area college students with mild depressive symptoms and/or subclinical psychotic symptoms (conferring an elevated risk for developing a psychiatric illness). Participants were randomly assigned to receive resilience training (n = 54, 7-12 per group) or to a waitlist (n = 53). The study was carried out between July 2018 and February 2020.
The study participants included 70 females (70%) and 30 males (30%) with a mean (SD) age of 18.8 (0.9) years. In this cohort, 30 (30%) self-reported as Asian, 6 (6%) Black, 12 (12%) Latinx, 55 (55%) White, and 9 (9%) multiracial or other race and ethnicity.
Compared to the waitlist control group, participants in the resilience training group reported significantly greater reductions in psychotic experiences, distress associated with these experiences. In addition, symptoms of depression and anxiety improved. Particpiants in the resilience training group reported significantly greater improvements in resilience, mindfulness, self-compassion, and positive affect following the 4-week resilience training intervention. Moreover, improvements in resilience-promoting skills were significantly correlated with symptom reductions. The observed reductions in psychotic experiences and associated distress were maintained at the 12-month follow-up assessment.
Resilience Training Also Reduces Loneliness
There has been a worldwide epidemic in loneliness evolving over the last several decades, especially among adolescents and young adults, and addressing loneliness has become a public health priority. In young people, multiple studies have shown an association between loneliness and lower quality of health, physical inactivity, low sleep quality, increased substance use, and impaired psychosocial functioning. In addition, loneliness is also a known risk factor for depression, anxiety, and suicidal ideation in young adults.
Thus far, psychosocial interventions focusing on reducing loneliness have primarily targeted older adults. In a secondary ad hoc analysis of the data gathered from the initial randomized, waitlist-controlled trial of RT, the research team examined whether RT was associated with reductions in loneliness (as measured using the well-validated UCLA Loneliness Scale before and after the intervention period).
In this analysis (DeTore et al, 2024), the research team observed that participants in the resilience training group experienced a greater decrease in loneliness than waitlist participants. Moreover, in the resilience training group, decreases in loneliness correlated significantly with increases in resilience, mindfulness, and self-compassion. These changes were not observed in the waitlist group. The reductions in loneliness remained significant after controlling for changes in resilience and mindfulness but not after controlling for increases in self-compassion, suggesting that the acquisition of self-compassion during RT contributed to the observed reductions in loneliness.
Next Steps
The results of these studies suggest that a brief resilience-enhancing group intervention may be an effective and easily scalable tool for improving resilience and reducing the experience of loneliness among at-risk young adults. One of the advantages of this intervention is that it is transdiagnostic. Rather than focusing on preventing one specific type of psychiatric illness (such as schizophrenia), the RT intervention is based on a growing body of evidence indicating that many psychiatric conditions share biological and environmental risk factors and respond to similar types of interventions. Thus, interventions focusing on individuals who may be at risk for a range of psychiatric illnesses may have significant benefits.
These findings highlight the potential of resilience training as a valuable intervention for reducing loneliness and improving mental health outcomes in at-risk young adults. Further research is needed to explore the long-term effects and mechanisms of RT, but the current results are promising for the development of scalable, cost-effective mental health interventions.
Current, ongoing studies of RT include: 1) a RT training program that involves training college staff to provide RT for their students, 2) a NIMH-funded adaptation and trial of RT for high school students (PI: DeTore), and 3) a NIMH-funded, randomized controlled, mechanistic trial of RT (PI: Holt) with follow-up assessments for two years, which will measure longer-term preventive effects of RT on clinical and academic outcomes, as well as brain function, in college students.
Read More
DeTore NR, Burke A, Nyer M, Holt DJ. A Brief Resilience-Enhancing Intervention and Loneliness in At-Risk Young Adults: A Secondary Analysis of a Randomized Clinical Trial. JAMA Netw Open. 2024 Feb 5;7(2):e2354728.
DeTore NR, Luther L, Deng W, Zimmerman J, Leathem L, Burke AS, Nyer MB, Holt DJ. Efficacy of a transdiagnostic, prevention-focused program for at-risk young adults: a waitlist-controlled trial. Psychol Med. 2023 Jun;53(8):3490-3499.
Burke AS, Shapero BG, Pelletier-Baldelli A, Deng WY, Nyer MB, Leathem L, Holt DJ. Rationale, Methods, Feasibility, and Preliminary Outcomes of a Transdiagnostic Prevention Program for At-Risk College Students. Front Psychiatry. 2020 Feb 25;10:1030.
Nicole DeTore, PhD is a clinical and research psychologist, Director of Research for the Resilience and Prevention Program (RAPP), and an Assistant Professor of Psychology at Harvard Medical School. Her research focuses on developing and studying interventions that can prevent the onset or reduce the severity of serious mental illnesses.
Anne Burke, PhD is the Director of Intervention Development in the Resilience and Prevention Program at Mass General Hospital and an Instructor in Psychology at Harvard Medical School. Her research through the Resilience and Prevention Program is focused on the development, evaluation, and implementation of transdiagnostic prevention and resilience enhancement interventions. She also provides individual, couples, and group therapy through the outpatient department as part of the Primary Care Psychiatry Team.
Maren Nyer, PhD, is the Director of Yoga Studies and the Associate Director of the Research Coordinator Program in the Depression Clinical and Research Program (DCRP), and an Assistant Professor of Psychiatry at Harvard Medical School (HMS). Her research interests include the treatment of mood disorders and associated symptoms, specifically developing and evaluating innovative and complementary and integrative treatments for depression.
Daphne Holt, MD, PhD is the Co-Director of the MGH Psychosis Clinical and Research Program, Director of the MGH Resilience and Prevention Program, and an Associate Professor in Psychiatry at Harvard Medical School. Using functional neuroimaging in combination with physiology, behavioral tasks and clinical assessments, she has investigated the neurocognitive basis of the core symptoms of psychotic illness, including delusions, negative affect and social impairment. Her research has also focused on identifying changes in brain function and behavior linked with risk for serious mental illness and has been developing novel interventions to increase resilience and potentially prevent serious mental illnesses in at-risk youth.
