Objective To determine whether cognitive therapy is effective in preventing the worsening of emerging psychotic symptoms experienced by help seeking young people deemed to be at risk for serious conditions such as schizophrenia.Design Multisite single blind randomised controlled trial.Setting Diverse services at five UK sites.Participants 288 participants aged 14-35 years (mean 20.74, SD 4.34 years) at high risk of psychosis: 144 were assigned to cognitive therapy plus monitoring of mental state and 144 to monitoring of mental state only. Participants were followed-up for a minimum of 12 months and a maximum of 24 months.Intervention Cognitive therapy (up to 26 (mean 9.1) sessions over six months) plus monitoring of mental state compared with monitoring of mental state only. Main outcome measures Primary outcome was scores on the comprehensive assessment of at risk mental states (CAARMS), which provides a dichotomous transition to psychosis score and ordinal scores for severity of psychotic symptoms and distress. Secondary outcomes included emotional dysfunction and quality of life.Results Transition to psychosis based on intention to treat was analysed using discrete time survival models. Overall, the prevalence of transition was lower than expected (23/288; 8%), with no significant difference between the two groups (proportional odds ratio 0.73, 95% confidence interval 0.32 to 1.68). Changes in severity of symptoms and distress, as well as secondary outcomes, were analysed using random effects regression (analysis of covariance) adjusted for site and baseline symptoms. Distress from psychotic symptoms did not differ (estimated difference at 12 months −3.00, 95% confidence interval −6.95 to 0.94) but their severity was significantly reduced in the group assigned to cognitive therapy (estimated between group effect size at 12 months −3.67, −6.71 to −0.64, P=0.018).Conclusions Cognitive therapy plus monitoring did not significantly reduce transition to psychosis or symptom related distress but reduced the severity of psychotic symptoms in young people at high risk. Most participants in both groups improved over time. The results have important implications for the at risk mental state concept.Trial registration Current Controlled Trials ISRCTN56283883.

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The ReACT Self-Harm Rule might be used as a screening tool to inform the process of assessing self-harm presentations to ED. The four risk factors could also be used as an adjunct to in-depth psychosocial assessment to help guide risk formulation. The use of multicentre data helped to maximize the generalizability of the tool, but we need to further verify its external validity in other localities.

With the release of the Canadian Psychological Association's (2018) response to the Truth and Reconciliation Commission of Canada (2015) there has been increased attention on the ways psychology in Canada might better serve the needs of Indigenous communities, in particular in terms of education and professional training. To date, there has been almost no research conducted at the intersection of Indigenous communities and professional training in psychology in Canada. This article examines this issue from the perspective of Indigenous psychologists who are working as scholar-practitioners in graduate level professional psychology training programs. Through first-person editorial reflections, the authors identify key challenges and opportunities in professional training in psychology relevant to Indigenous peoples; and the changes that are needed to advance Indigenous peoples in the field. Finally, the study identifies various paradigms of professional training that hold promise for serving the interests of Indigenous peoples in professional training in psychology. Public Significance StatementThis study identifies challenges, opportunities, and strategies for the advancement of Indigenous peoples in the field of professional psychology, particularly through the lens of professional training and education. In addition, the study considers how professional training can better support the preparation of Indigenous and non-Indigenous students and psychologists to address the mental health needs of Indigenous communities.

Tearful crying is a ubiquitous and likely uniquely human phenomenon. Scholars have argued that emotional tears serve an attachment function: Tears are thought to act as a social glue by evoking social support intentions. Initial experimental studies supported this proposition across several methodologies, but these were conducted almost exclusively on participants from North America and Europe, resulting in limited generalizability. This project examined the tears-social support intentions effect and possible mediating and moderating variables in a fully pre-registered study across 7,007 participants (24,886 ratings) and 41 countries spanning all populated continents. Participants were presented with four pictures out of 100 possible targets with or without digitally-added tears. We confirmed the main prediction that seeing a tearful individual elicits the intention to support, d = .49 [.43, .55]. Our data suggest that this effect could be mediated by perceiving the crying target as warmer and more helpless, feeling more connected, as well as feeling more empathic concern for the crier, but not by an increase in personal distress of the observer. The effect was moderated by the situational valence, identifying the target as part of one's group, and trait empathic concern. A neutral situation, high trait empathic concern, and low identification increased the effect. We observed high heterogeneity across countries that was, via split-half validation, best explained by countrylevel GDP per capita and subjective well-being with stronger effects for higher-scoring countries. These findings suggest that tears can function as social glue, providing one possible explanation why emotional crying persists into adulthood.

These findings suggest that internalized stigma may contribute to the development and maintenance of depression in young people at risk of psychosis.

Our study aimed to expand the currently limited evidence base for best practice in interventions for individuals at high risk of psychosis.

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