Blended delivery of cognitive-behavioural therapy for repetitive negative thought within mental health support teams in schools as scalable early intervention for anxiety and depression

Repetitive negative thought (RNT)—including worry, rumination, overthinking—is increasingly common in young people and contributes significantly to the onset and maintenance of anxiety and depression in youth. Reducing RNT is a well-established active therapeutic ingredient. Multiple randomized controlled trials show that cognitive-behavioural therapy (CBT) focused on RNT effectively reduces and prevents RNT, anxiety, and depression in youth. However, this intervention is not yet widely accessible. This project aims to scale up CBT-for-RNT by adapting it for integration into Mental Health Support Teams (MHSTs), which are expanding to all schools in England. We will adapt group-based and supported digital formats aligned with current service delivery models. In the Foundation phase, our key goals are to co-adapt the intervention for MHSTs, map implementation and sustainability pathways, and design a definitive trial to evaluate effectiveness and cost-effectiveness, to be conducted in the Impact phase. We hypothesize that CBT-for-RNT will be more effective and cost-effective than treatment-as-usual. Young people with lived experience will play a central role in shaping research questions, co-designing intervention adaptations, and informing implementation strategies. This project will deliver scalable, economical, and impactful early interventions for common mental health problems in young people, with potential to transform school-based mental health support globally.