ArticleEClinicalMedicine2026
A digitally embedded intervention to enhance psychological decentering and reduce depression severity in at-risk adolescents: a randomised controlled trial of the 'One Step Back' programme.
Article in EClinicalMedicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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17 authors.
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Abstract
Background: Adolescence is a critical period for early mental health interventions. Scalable, evidence-based interventions for at-risk adolescents without severe symptoms are limited. We developed a low-intensity, digital programme to train psychological decentering (the ability to disengage from unwanted thoughts, feelings, and memories) as a core psychotherapeutic process for improving mental health. Methods: A two-arm randomised controlled trial compared a 5-week psychological decentering training ('One Step Back': OSB) programme with an active control (CTL) comprising physical and cognitive exercises (May 2021 to November 2022; ISRCTN14329613). Adolescents at-risk of depression were recruited through UK secondary schools, then randomised into trial arms (n = 114, 84% female; Findings: OSB was associated with improvements in self-reported decentering scores at post-intervention compared with CTL (M difference = 4.16 [95% CI 1.85-6.51]; p = 0.002; Cohen's d = 0.61). OSB participants reported decreased depression (M difference = -5.54 [95% CI -9.14 to -1.93]; p = 0.003, d = -0.60) and increased well-being (M difference = 4.53 [95% CI 1.21-7.86]; p < 0.001, d = 0.76). Interpretation: Psychological decentering was selectively trained in at-risk adolescents through a brief digital intervention. Training resulted in significant reductions in depression severity. Findings support this low-intensity approach to support adolescents before symptoms worsen. Funding: This project was funded by a Wellcome Strategic Award (Wellcome Ref 104908/Z/14/z; awarded to TD, S-JB, WK, and J. Mark G. Williams) and the UK Medical Council (Grant Reference: MC_UU_00030/5; awarded to TD). The contribution of MPB was partially supported by a Wellcome Trust Active Ingredients in Mental Health Commission. RCK was funded by an Economic and Social Research Council Doctoral Fellowship (ref SUAI/067). SJB is funded by Wellcome (grant number WT107496/Z/15/Z), the MRC, the Jacobs Foundation, the Wellspring Foundation, and the University of Cambridge.
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