Title: Coping with Unusual ExperienceS for 12-18 year olds (CUES+): A transdiagnostic randomised controlled trial of the effectiveness of cognitive therapy in reducing distress associated with unusual experiences in adolescent mental health services.
Funder: Department of Health (England)

Abstract: Background: The National Institute of Health and Care Excellence (NICE) recommends individual, specialised cognitive behavioural therapy (CBTp) for young people with psychosis, or unusual experiences associated with distress (UEDs). Psychosis, although rare in childhood, increases in incidence in adolescence, and incurs high personal and societal costs. Unusual experiences occur frequently in childhood, and are associated with distress in about 15% of the general population and half of young people in contact with Child and Adolescent Mental Health Services (CAMHS). Persistence into adolescence is marked by a greater likelihood of associated distress and adverse impact. UEDs are characteristic of psychosis, but also occur in the context of a range of other mental health presentations. UEDs impact adversely on recovery, and increase the future risk of developing severe mental health conditions including psychosis. CBTp aims to reduce current distress, improve recovery and promote resilience to future mental health problems There is evidence for clinical and cost effectiveness in adults, and the potential cost savings of early intervention in childhood are considerable. However, access to CBTp in community CAMHS is limited by a lack of training and expert supervision, and by sub-optimal links with Early Intervention in Psychosis (EIP) and early detection services. UEDs are not routinely assessed, and young people tend not to report them unless directly asked, so they may go undetected. Moreover, the NICE recommendations are based on adult research, and the guidance calls for more studies focused exclusively on young people. Aims: To address this call, we plan to test the clinical and cost-effectiveness of CBTp, as an adjunct to routine care, in reducing distress in adolescents (aged 12-18) with UEDs in the context of psychosis or any other mental health presentation, in community CAMHS. We will also develop a model of service provision to enable young people with UEDs to be identified earlier and offered appropriate, specialist psychological intervention. Research Questions: 1) Are clinical outcomes for young people with UEDs improved by the addition of CBTp to routine care? 2) Are the effect sizes comparable to those found in the adult literature? 3) Is the intervention cost-effective? Plan of Investigation: We will screen all new consenting referrals to participating teams Adolescents reporting UEDs, irrespective of their psychiatric presentation, will be invited to participate in the trial. They will be randomised in a 1:1 ratio, stratifying for site and problem severity, to receive CBTp in addition to routine care immediately, or after 24 weeks. CBTp will comprise 12-16 weekly sessions, incorporating 3-4 sessions of family support. We will measure a range of outcomes including distress, UEDs, and costs at 0, 16 and 24 weeks. After 24 weeks the routine care only group will be offered the intervention. We will compare the groups on our primary outcome of distress at 16 weeks (end of therapy/waitlist). Secondary outcomes will be UEDs, service use and QALYs (Quality Adjusted Life Years). We will train local therapists to deliver the intervention, provide specialist supervision, and liaise closely with local EIP and early detection services. Summary of Potential Benefits: The primary benefit will be to young people with UEDs and their families, who will have earlier access to specialist psychological interventions, and improved outcomes. The local service will benefit from the workforce development focus and local stakeholders will benefit from improved access and greater clarity regarding pathways to care for young people with UEDs. The therapy and training specifications and the clinical and cost effectiveness data will be relevant both to NICE guidance implementation and the further development of the Improving Access to Psychological Therapies initiative for Children and Young People (IAPT-CYP).


Research activity codes: 6.6 PSYCHOLOGICAL AND BEHAVIOURAL
Health categories: MENTAL HEALTH