The treatment of anxiety and depression in young people at risk of psychosis
A high-risk mental state for psychosis (HRMS) is a condition in which a person may exhibit symptoms, behaviors, or indicators that suggest a high likelihood of developing a psychotic disorder in the short term. For example, the person may feel watched or monitored while walking down the street, may have the sensation that people are laughing or talking about them, or that their thoughts can be overheard. They may also hear sounds, whispers, or voices, or smell or see things that other people do not perceive.
Typically, these are psychotic experiences that do not reach the intensity, frequency, or duration sufficient to diagnose a psychotic disorder. It is not a diagnostic category in itself; an EMAR refers to a transient state of risk for the individual that can last up to five years.
Detect and prevent the risk of developing a psychotic disorder
How can an EMAR evolve?
It is estimated that 25% of individuals who meet the criteria for acute multidrug-associated psychosis (AMD) will develop a full-blown psychotic disorder within three years (Salazar de Pablo et al., 2021). In addition to the likelihood of developing a first psychotic episode, approximately 80% of individuals with AMD often present with other associated non-psychotic disorders such as depression, substance use, or anxiety disorders (Spitery-Staines et al., 2024). Beyond psychosis, nearly half of individuals with AMD may experience attenuated psychotic symptoms in the medium term (Salazar de Pablo et al., 2021). One of the goals of healthcare services is to offer effective, evidence-based treatments to individuals at risk of developing mental disorders that can become chronic.
How is a high-risk mental state for psychosis diagnosed?
If a person experiences these symptoms, especially if they are accompanied by significant distress , they should seek help. Initially, they can visit their primary care center and request an appointment with their family doctor. There, an assessment will be conducted, and a decision will be made regarding whether a referral to a community mental health team is necessary. A mental health specialist will explore the symptoms and work with the individual to determine the next steps. In these cases, the treatment of choice is psychological therapy combined with medication to help alleviate the symptoms.
80% of people who meet EMAR criteria have other associated disorders such as depression, substance use, or anxiety disorders.
Mental disorders in young people do not appear overnight, but rather tend to develop gradually . Initially, mild and varied symptoms (anxiety, mood, substance use, or psychotic) often appear, which can increase in intensity, frequency, and duration until they become chronic disorders (McGorry et al., 2018).
Emotional self-regulation in psychotic disorders
A single psychological treatment for various associated disorders
Currently, we have the option of using a single treatment for individuals with multiple disorders or various emotional symptoms, such as emotional distress, depression, and anxiety disorders, among others. The Unified Protocol for the Transdiagnostic Treatment of Emotional Disorders (Barlow et al., 2011) (UP, hereafter) has demonstrated its effectiveness in treating various disorders, including anxiety and depression, in both individual (Eustis et al., 2020) and group (Peris Baquero et al., 2023) settings, and is being implemented in public health facilities in Spain.
We can use a single treatment for people who have more than one disorder or different emotional symptoms such as EMAR, depression, and anxiety disorders.
The main objective of the PU is to teach strategies for improving the regulation of intense emotions that cause distress, such as anxiety, sadness, guilt, or shame, among others. These intense emotions are present in both emotional and psychotic disorders.
The PU, therefore, is a cognitive-behavioral psychological intervention that consists of equipping the person with tools to regulate the intense emotions that cause them distress and prevent them from achieving their goals. How?
- First, the adaptive function of emotions is explained and their components (thoughts, physical sensations and behaviors) are identified.
- Subsequently, the person learns new skills to tolerate and respond adaptively to intense emotions, whether it be sadness, fear, anxiety, anger, shame, guilt, or joy.
- Finally, the person, with the support of the therapists, is gradually exposed to the situations that cause discomfort while using the strategies worked on in therapy.
This psychotherapy has been shown to be equally or more effective than other treatments for people with emotional disorders such as anxiety or depression (Barlow et al., 2017), and its group application is equally effective, with results lasting even after therapy ends. A recent study found that positive results persisted fifteen months after the intervention concluded (Peris-Baquero et al., 2023).
Featuring
