Surprises as a mechanism of improvement in the psychological therapy of anxiety and depression in young people

Social anxiety and depression are common in young people and often co-occur, leading to substantial impairment. However, young people can also experience great improvements in both their anxiety and depressive symptoms when they are treated with Cognitive Therapy for social anxiety disorder.

Our programme will deliver a novel mechanistic understanding of anxiety and depression improvement and enhance our ability to maximise these benefits by answering the following questions:

- What mechanisms underlie young people's improvement in anxiety and mood symptoms and how we can maximise these benefits for each individual.

- Whether the mechanisms of the intervention and their use for treatment seem meaningful and ethically acceptable to young people.

We hypothesise that successful Cognitive Therapy for social anxiety relies on positive surprises in social interactions, such that young people experience better outcomes than they expected. We also hypothesise that such surprises only happen if young people modify specific aspects of self-processing, such as self-focused attention and negative self-imagery.

We will directly manipulate the putative processes and delineate their neural and interoceptive underpinnings across five work packages. We will examine the ethics and acceptability of our mechanistic research in co-design and co-production with young people in a separate cross-cutting work package.