Recalling and Anticipating Specific Positive Events to Boost Resilience in Adolescents

Study Overview
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Brief Summary
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Many young people are experiencing stress-related mental health problems, with some recent studies suggesting this number is increasing. Especially now, in the context of the COVID-19 pandemic, there is a significant increase in depression and anxiety in adolescents. An important way to help address this challenge is not so much to focus on trying to repair what makes young people vulnerable but to focus on building resilience. Resilience refers to the ability to successfully deal with stressful experiences. Recent research shows that being able to vividly remember and imagine positive events can buffer the negative consequences of stress, and makes a convincing case that training adolescents in recalling and anticipating positive events would promote resilience and thereby improve their mental wellbeing. And this is exactly what the current project sets out to do for the very first time. Adolescents will receive a playful group-training in school to make them better at recalling and anticipating positive events, which is expected to help them to bounce back more swiftly from challenging or otherwise stressful life events. The investigators predict that youngsters who follow our Positive Event Training will experience more positive emotions, will show improved resilience and report better mental wellbeing. The investigators will also develop a free online training protocol for teachers so that schools can provide this resilience program on their own, without the need of external professional trainers.

Official Title
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Recalling and Anticipating Specific Positive Events to Boost Resilience in Adolescents

Conditions
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Specific Positive Memories, Specific Positive Future Events, Resilience, Mental Wellbeing

Intervention / Treatment
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* Behavioral: Positive Events Training (PET)
* Behavioral: CREAtive writing Training (CREAT)


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: All adolescents of the selected classes of the participating schools (12-16 years; 1st and 2nd grade of secondary school) who want to take part in the study and give informed consent (own informed consent and active parental informed consent) will be allowed to take part in the study. To minimize the risk of too much heterogeneity in our final sample, for instance due to context factors related to the type of education, the investigators will first recruit classes of adolescents that follow general secondary education. Future studies (after PET has been properly evaluated in this study) should also be conducted in samples of adolescents following other types of secondary education. Exclusion Criteria: -

Ages Eligible for Study
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Minimum Age: 12 Years
Maximum Age: 16 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: A cluster randomized-controlled trial design will be used with a two (condition: PET vs. active control) x three (time-point: baseline, post-training and FU) factorial-design.
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Intervention group<br>Classes that will follow Positive Events Training. | Behavioral: Positive Events Training (PET)<br>* PET is a group-based training program combining Memory Specificity Training (MEST; Raes, 2007) and Future Event Specificity Training (FEST; Dutch version of Hallford et al. (2020): Changing the Future: An initial test of Future Specificity Training). It comprises four sessions of 50 minutes each. The training is delivered in a standardized manner, using the Positive Event Training Manual developed for this study (content adapted from our MEST and FEST manuals). Following brief psychoeducation on the rationale, participants practice generating detailed specific memories and future events using neutral and positive cue-words. Participants are maximally supported and challenged by the trainer and by the other group-members to generate very specific and highly detailed memories and future events using mental imagery and drawing upon visual, olfactory, auditory and emotional elements of the events, including both contextual and sensory-perceptual details.<br>|
| Active Comparator: Control group<br>Classes that will follow Bogus Control Training. | Behavioral: CREAtive writing Training (CREAT)<br>* CREAT follows the exact same format and length as the PET training (i.e., delivered by a trainer in group over 4 x 50-minute sessions, including homework exercises). Following brief psychoeducation on the (bogus*) rationale behind PET, participants complete a series of creative writing exercises using funny and thought-provoking writing prompts. Just as in PET, participants are maximally supported and challenged by the trainer and by the other group-members, in this case to generate completions that are as creative and funny as possible. The investigators used CREAT successfully before in an online format as a bogus control training for a memory specificity training. (*) The investigators tell participants that these creative writing exercises have been found to be beneficial for mental wellbeing, as creative writing exercises cultivate creativity and stimulate participants' imagination skills.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in Resilience | Connor-Davidson Resilience Scale (CD-RISC, short version) to assess resilience - This scale consists of 10 items (e.g., Dealing with stress makes me stronger.) that are rated on a 5-point Likert scale going from 1 (not at all) to 5 (very often), with higher scores indicating higher resilience. | 1 week before the intervention, 1 week after the intervention and 2 months after the intervention. | 
| Change in Mental wellbeing | Short Warwick-Edinburgh Mental Wellbeing Scale (SWEMWBS; Stewart-Brown et al., 2009) to assess mental wellbeing - The SWEMWBS consists of seven statements (e.g., I felt relaxed.) about thoughts and feelings that are scored on a 5-point Likert scale ranging from 1 (never) to 5 (always). Higher scores reflect higher mental wellbeing. | One week before the intervention, one week after the intervention and two months after the intervention; The SWEMWBS consists of seven statements (e.g., I felt relaxed.) about thoughts and feelings that are scored on a 5-point Likert scale ranging from | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in Positive affect | Positive Affect subscale of the Positive and Negative Affect Schedule Scales (PANAS; Watson et al., 1988) to assess positive affect - The Positive Affect subscale of the PANAS consists of 10 items (words) that describe positive feelings (e.g., excited). Items are rated on a 5-point Likert scale going from 1 (very slightly or not at all) to 5 (extremely), where with higher scores reflecting higher positive affect. | One week before the intervention, one week after the intervention and two months after the intervention | 
| Change in Positive affect regulation | Dampening and Savoring subscale of the Responses to Positive Affect scale, child version (RPA-C; Bijttebier et al., 2012) to assess positive affect regulation - The RPA-C consists of items reflecting both dampening items (e.g., When you felt happy, how often did you think: I don't deserve this?) and savoring items responses (e.g., When you felt happy, how often did you notice that you felt full of energy?). All 17 items are rated on a 4-point Likert scale ranging from 1 (not at all) to 4 (very often). | One week before the intervention, one week after the intervention and two months after the intervention | 
| Change in Anhedonia | Leuven Anhedonia Self-report Scale (LASS, 2nd version; Nelis, Bastin, Raes, & Bijttebier 2018) to assess symptoms of anhedonia - The 12All 12 items (e.g., There were few things I looked forward to.) are rated on a 5-point Likert scale going from 1 (completely untrue) to 5 (completely true) with higher scores reflecting higher levels of anhedonia. | One week before the intervention, one week after the intervention and two months after the intervention | 
| Change in Dampening | Leuven Exeter Dampening Scale - General (LEDS, unpublished) to assess dampening.- The LEDS-G consists of 13 items (e.g., I can only be happy if others are too.) that are rated on a 5-point Likert scale. Compared to the RPA dampening subscale, the LEDS-G aims to cover a larger variety of dampening appraisal styles. | One week before the intervention, one week after the intervention and two months after the intervention | 
| Change in Savoring | Savouring Items for the Four-Factor Model of the Abridged Ways Of Savoring Checklist in Response to Everyday Events (Original scale Bryant and Vernoff, 2007; Four-Factor Model Chadwick, 2012) to assess savoring. - Items (e.g., I looked for other people to share it with.) are rated on a 7-point Likert scale going from 1 (totally disagree) to 7 (totally agree), with higher scores reflecting higher levels of savoring. | One week before the intervention, one week after the intervention and two months after the intervention | 
| Change in Depressive symptoms and stress | Depression, Anxiety, and Stress Scale (DASS-21; Lovibond & Lovibond, 1995) to assess basic mental health to control for baseline differences in the training groups, and to explore the generalised effect of PET on levels of depressive symptoms and stress at post-intervention and at follow-up. - The DASS-21 consists of 21 items (e.g., I felt like my life had no meaning.) that are rated on a 4-point Likert scale going from 0 (never) to 3 (almost always). | One week before the intervention, one week after the intervention and two months after the intervention | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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wellbeing, adolescents, anhedonia, dampening, episodic future thinking, memory specificity, positive emotions, resilience, savoring