"Flashforward" imagery and anxiety in young adults: Risk mechanisms and intervention development

Young adulthood (16-24-years old) is a crucial time in one's life. Many young adults begin to establish their independence through education, work and relationships. However, this is also a time when many people are vulnerable to mental health problems.

One in five young adults are likely to experience a mental health disorder. Anxiety problems in particular can significantly disrupt a young adult's daily life and reduce their ability to thrive. Despite the need for mental health support, many young adults struggle with accessing it due to a variety of reasons, including stigma, long waiting lists, splitting of services (in the transition to adult services at age 18), and disruptions to care resulting from geographical mobility.

We need new approaches to prevent and intervene early, which are also effective, accessible and appealing.

This fellowship explores a promising new intervention for anxiety problems that looks less like traditional "therapy" and is informed by recent scientific research. This research suggests that when people experience anxiety, they also spontaneously visualise future scenarios that are making them anxious. These are also known as "flashforward" mental images, because they rapidly and mentally project us into the future.

The ability to imagine the future is really helpful, for example it can help us plan a trip or prepare for an interview. However, repeatedly visualising anxious scenarios can make them seem more real and more likely to happen, making anxiety worse. Therefore, it is important that we find ways to deal with these images to reduce their emotional impact.

New research has shown that holding a visual image in mind while also doing certain activities (such as playing a popular shape-fitting videogame called Tetris) makes the mental image less intense, less vivid, and less likely to intrude afterwards. This is presumably because doing two activities at the same time can be difficult, particularly when both (holding an image in mind and playing Tetris) use similar (visual) brain resources.

There will be three separate projects to better understand these "flashforward" images in young adults, how they make anxiety worse, and how to change them. The first project will ask young adults to complete an online survey three times (with six-month gaps). This will help us understand if knowing about flashforward images at one time point can help us anticipate if anxiety problems will develop much later on (e.g. in six months to a year).

The second project will ask young adults to complete multiple brief ratings per day (for two weeks) using their smartphones of their moment-to-moment experiences, an approach called experience sampling. This will help us understand how these mental images impact on their anxiety levels and associated problems in daily life. The third project will develop a new (Tetris-based) intervention and deliver it to a group of young adults.

This will help us understand whether this new intervention can modify flashforward images, resulting in a reduction in anxiety levels and their associated problems. If so, this intervention can be tested in future in an even more rigorous way. Together, the three projects will help us know if this intervention has the potential to be an effective strategy for early intervention and/or prevention for anxiety problems for young people.

Young adults with lived experience of anxiety problems will be involved across all stages of the project from design to dissemination. For this purpose, a Youth Advisory Group will be set up with around 6 young adults while ensuring diversity (e.g. in sex, gender identity, ethnicity and socioeconomic background). A youth collaborator from this group (a role which can be rotated) will additionally help with more specific research activities, such as reviewing materials, data collection and subsequent analyses.