Abstract
BackgroundChildhood ‘unusual experiences’ (such as hearing voices that others cannot, or suspicions of being followed) are common, but can become more distressing during adolescence, especially for young people in contact with Child and Adolescent Mental Health Services (CAMHS). Unusual experiences that are distressing or have adverse life impact (UEDs) are associated with a range of current and future emotional, behavioural and mental health difficulties. Recommendations for psychological intervention are based on evidence from adult studies, with some support from small, pilot, child-specific evaluations. Research is needed to ensure that the recommendations suit children as well as adults. The CUES+ study (Coping with Unusual ExperienceS for 12–18 year olds) aims to find out whether cognitive behaviour therapy for UEDs (CBT-UED) is a helpful and cost-effective addition to usual community care for 12–18 year olds presenting to United Kingdom National Health Service Child and Adolescent Mental Health Services in four London boroughs.MethodsThe CUES+ study is a randomised controlled trial comparing CBT-UED plus routine care to routine care alone. CBT-UED comprises up to 16 sessions, including up to 12 individual and up to four family support meetings, each lasting around 45–60 min, delivered weekly. The primary outcome is emotional distress. Secondary outcomes are change in UEDs, risk events (self-harm, attendance at emergency services, other adverse events) and health economic outcomes. Participants will be randomised in a 1:1 ratio after baseline assessment. Randomisation will be stratified by borough and by severity of mental health presentation: ‘severe’ (an identified psychotic or bipolar disorder) or any ‘other’ condition. Outcomes will be assessed by a trained assessor blind to treatment condition at 0, 16 and 24 weeks. Recruitment began in February, 2015 and is ongoing until the end of March, 2017.DiscussionThe CUES+ study will contribute to the currently limited child-specific evidence base for psychological interventions for UEDs occurring in the context of psychosis or any other mental health presentation.Trial registrationInternational Standard Randomised Controlled Trials, ID: ISRCTN21802136. Prospectively registered on 12 January 2015. Protocol V3 31 August 2015 with screening amended.
Highlights
Childhood ‘unusual experiences’ are common, but can become more distressing during adolescence, especially for young people in contact with Child and Adolescent Mental Health Services (CAMHS)
The CUES+ study will contribute to the currently limited child-specific evidence base for psychological interventions for UEDs occurring in the context of psychosis or any other mental health presentation
On the strength of the adult evidence base, similar recommendations are made for children and young people under the age of 18 years [4, 9]
Summary
Childhood ‘unusual experiences’ (such as hearing voices that others cannot, or suspicions of being followed) are common, but can become more distressing during adolescence, especially for young people in contact with Child and Adolescent Mental Health Services (CAMHS). Unusual experiences that are distressing or have adverse life impact (UEDs) are associated with a range of current and future emotional, behavioural and mental health difficulties. The CUES+ study (Coping with Unusual ExperienceS for 12–18 year olds) aims to find out whether cognitive behaviour therapy for UEDs (CBT-UED) is a helpful and cost-effective addition to usual community care for 12–18 year olds presenting to United Kingdom National Health Service Child and Adolescent Mental Health Services in four London boroughs. The guidance extends the offer of treatment to childhood presentations of psychotic-like, or unusual experiences (such as hearing voices that others cannot, or unfounded worries about being followed or deliberately harmed) in the absence of a formal diagnosis of psychosis, or any other condition, when these are accompanied by distress or adverse life impact (UEDs). For younger adolescents (aged under 14 years), recent guidance suggests that the lack of specificity of UEDs as a risk factor for psychosis contraindicates explicitly preventative interventions [20, 21]
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