Mental illness is a growing concern in Canada. It impacts the emotional, physical and social well-being of those affected and their families. Mental illness often develops in adolescence or young adulthood, with genetics acting as a strong predictor.
Knowing that mental illness typically runs in families where genetic predispositions are met with environmental factors, Dalhousie’s Drs. Rudolf Uher and Barbara Pavlova are leading a novel initiative based on the hypothesis that early interventions – either in childhood or adolescence – can interrupt this cycle. With a goal of reducing the risk of mental illness, including bipolar disorder, major depression, anxiety disorders and schizophrenia, the Families Overcoming Risks and Building Opportunities for Well-Being (FORBOW) study is currently testing whether a variety of early interventions can prevent these conditions from occurring.
“These illnesses can be extremely disabling, limiting the ability of those affected to reach their full potential in life,” says Dr. Rudolf Uher. “These are also some of the most expensive, chronic illnesses to treat, and early intervention could benefit everyone, from individuals and families to taxpayers and society.”
The FORBOW team recruits families from Nova Scotia, including families where one or both parents are affected by mental illness, and monitors them over at least five years. FORBOW researchers are testing two major intervention programs called COACH (Courageous Parents, Courageous Children) and SWELL (Skills for Wellness). While both the COACH and SWELL programs utilize Cognitive Behavioural Therapy (CBT) to help individuals develop mental health skills, the former focuses on teaching parents to coach their young children to develop in a healthy way, where the latter works with older children and adolescents directly.
“If you have a parent with an anxiety disorder and their child has a shy or inhibited temperament, there’s a very high likelihood they will develop an anxiety disorder themselves – well over 50 per cent,” says Dr. Pavlova. “Understanding that the development of mental illness depends on both genes and environment, we believe we can limit the passing on of mental illness by training parents to be careful of the behaviours they exhibit, thereby removing the environmental influences that interact with genetic vulnerabilities.”
The latest research suggests that anxiety is passed down mainly through environmental factors and the skills parents can equip their children with are of crucial importance to help shy children avoid growing up into anxious adults.
Working with anxious parents to provide them with coping strategies, as well as how to use those strategies in parenting their children, the goal of COACH is to ultimately help adults parent their children in an “anti-anxiety way”. In this highly personalized program, the FORBOW team meets with parents to first assess their anxieties, and then works with them for up to 16 one-on-one sessions to help them manage their anxiety through CBT techniques.
Dr. Pavlova says. “Through our work, we help people with anxiety discover that while their fears seem very likely to happen in their minds, in reality they are unlikely to happen and/or the consequences are much less than they expect.”
Catered specifically to each individual, interventions vary depending on the different forms, manifestations, and triggers of anxiety. Combining interactive interventions with independent homework and behavioural exercises, the final stage of the COACH program is to teach parents to apply the strategies they learn when it comes to parenting their children. With up to 8 one-on-one sessions dedicated to translating the program’s strategies to parenting methods, the hope is that parents can learn to parent their children in a way that makes it less likely they too will develop an anxiety disorder.
Similar to the COACH program for adults, the SWELL program seeks to help children and adolescents, aged 9-21, learn skills and strategies that don’t just help them solve their current difficulties, but also prevent depression, bipolar disorder and other forms of mental illness. Gathering initial information from young participants through interactive activities, games, and discussions, the SWELL program follows a progression of one-on-one assessments and interventions. Using CBT techniques in a skills coaching context, the SWELL program aims to train healthy behavioural and thought patterns in young participants, to ultimately stop the development of severe mental illness.
COACH and SWELL are just the beginning. FORBOW researchers are also preparing novel interventions that may positively alter brain maturation at key developmental periods. Dr. Uher and his colleagues are deploying an innovative combination of molecular genetics and brain imaging to target such interventions to the individuals who are most likely to benefit.
The intent of the FORBOW project is to track families and young participants from the SWELL and COACH programs over 10-15 years and determine if early intervention can indeed prevent mental illness. In order to do this, however, significant sustained funding is required. Given that typical grant funding only covers short-term studies, the FORBOW project depends on the support of organizations like DMRF to carry out more meaningful, long-term research.
“We firmly believe that the earlier we intervene, the bigger difference we can make, but this needs to be proven over time,” says Dr. Uher. “If we want to minimize mental illness and increase the health and happiness of our society, the continuation of this study is essential.”