By Meadowlark Monaghan, AIM Youth Advisory Board Member
Welcome to Research Updates! A new series where we share interviews with our doctors and fellows conducting groundbreaking research on all aspects of youth mental health.
Dr. Hannah Lawrence is an assistant professor at Oregon State University in the School of Psychological Science where she leads the Translational Imagery Depression and Suicide (TIDES) Lab. Dr. Lawrence’s program of research examines the role of problematic cognitions, or thinking patterns, in youth internalizing disorders and tests the efficacy of new interventions designed to help youth disengage from these negative thinking patterns. She aims to develop treatments that are scalable and delivered to youth in the very moments in which they need support.
Dr. Lawrence’s study is well-positioned to test whether a smartphone-delivered mindfulness intervention reduces anxiety and depressive symptoms in adolescents by helping them disengage from repetitive negative thought (RNT). By delivering mindfulness skills in response to adolescents’ reports that they are engaged in RNT, adolescents receive support in the very moments and settings in which they need them.
In addition, this approach is highly scalable, and thus has the potential to reach a greater number of adolescents than traditional psychotherapy, increasing access to care for the many youth who need mental health support.
Hi Dr. Lawrence! Please tell us about your study.
The goal of the AWARE Study is to learn how we can better help teens get unstuck from unhelpful thinking patterns.
We all think about or imagine negative things from the past or worry about negative things that could happen in the future. When we get stuck dwelling on these things, however, we can start to experience anxiety or depressive symptoms. In our study we hope to understand teens’ experiences while they are stuck in negative thinking patterns by having them think about or imagine something negative from their past or future while we collect data on their breathing, heart rate, and mood.
We also hope to help teens get unstuck from these negative thinking patterns more easily in their daily lives. To do this, we send teens quick surveys to their smartphones three times per day. When they tell us they are stuck in negative thinking patterns we send them a quick, 1-2 min mindfulness exercise to try out at that very moment. Teens also fill out questionnaires about their mental health throughout the study to see whether the mindfulness skills help them get unstuck from negative thinking patterns and also help improve their anxiety and depressive symptoms.
How did this study come about for you?
In my clinical work, I often would work with teens who would get stuck thinking about the past (i.e., ruminating) or worrying about the future. We would meet once per week for therapy and work on skills to get unstuck from negative thinking patterns but oftentimes it was challenging for teens to implement or practice these skills in daily life. We wanted to test an intervention that could help teens throughout the day or help them practice some of these skills between therapy sessions.
Why was mindfulness chosen as the targeted intervention?
There is a strong body of research that shows us that mindfulness can help reduce RNT, but less is known about how well it works for adolescents who engage in RNT or when it is delivered using an ecological momentary intervention where shorter skills are sent to teens in response to their answers on smartphone surveys. We wanted to use an intervention with good research backing but apply it in a new, potentially even more helpful, way.
What does the mindfulness intervention look like?
We have 30 different mindfulness exercises to keep things engaging for teens. Each exercise is a short 1-2 min video that helps teens focus on their breath, do a body scan, or observe and distance themselves from their thoughts/mental images.
What is the benefit of delivering an intervention at the moment of need vs. building a mindfulness practice over time?
There are benefits to both brief mindfulness skills and also developing a mindfulness practice over time. Some research from Dr. Lori Hilt testing a similar mindfulness intervention for teens found that the vast majority of adolescents prefer shorter mindfulness skills to longer ones so we went with what teens want! We are also continuing to ask teens for their feedback throughout our study to continually improve our intervention and how we deliver it.
How do you see intervention applications like this developing in the upcoming years?
Digital mental health interventions are taking off, especially with teens! There is lots of research to support many digital health interventions and also some data that tells us that teens prefer to get mental health information on digital platforms. I hope that in the coming years we see even more integration between digital health interventions and therapist-led interventions.
For example, it would be great if teens engaged in a digital health intervention could access a licensed mental health provider if symptoms worsen or if they need more support in a given moment. It also could be very helpful to therapists if their teen clients could have access to digital health interventions in between therapy sessions to practice the skills they are learning in therapy.
I also hope to see teens have more agency in deciding which interventions might work best for them and if and when they need them. It is often adults who are developing these interventions and then delivering them to teens without teen feedback. We need to involve teens from the ground up in intervention development and decision making if we are really going to help promote teen mental health on a large scale.
About the Author
Meadowlark Monaghan (she/hers) is a consultant using her knowledge gained as a mental health professional to act as a liaison between brands, creators, + online communities with the field of psychology and mental health. She also co-hosts the personal development podcast, Thoughts May Vary. Her work has been seen with Madhappy, Local Optimist, The Mayfair Group, Lonely Ghost, AIM Youth Mental Health, NAMI San Diego and more.