Enhancing resilience and frontohippocampal connectivity in youth with psychotic experiences

D.J. Holt^1,. ¹Massachusetts General Hospital and Harvard Medical School, Psychiatry, Boston, United States.

Transdiagnostic prevention approaches in mental health have gained traction in recent years. However, it remains unclear exactly who should receive them and which outcomes should be targeted, particularly given the clinical and biological heterogeneity observed in “at-risk” youth. To investigate these questions, we have conducted a series of studies that measured the effects of brief, group-based behavioral interventions in at-risk youth. Resilience Training (RT) is a 4-session intervention initially designed for non-help-seeking young adults (e.g., college students) who endorse psychotic experiences (PEs) and/or mild depression. A randomized, waitlist-controlled trial showed that RT enhances capacities linked to resilience (the ability to weather stress), such as mindfulness and self-compassion, and reduces PEs, depression and loneliness (1, 2). Follow-up work suggested that reductions in emotion reactivity and changes in hippocampal-frontal connectivity play a role in these RT-related improvements (3). Lastly, a pilot study of a similar group-based intervention tailored for adolescents (n=30, mean age: 12 years) revealed similar effects on symptoms and hippocampal-frontal connectivity. Taken together, these findings suggest that brief resilience-boosting behavioral interventions can produce a range of beneficial effects in non-help-seeking, transdiagnostically at-risk youth, which may be mediated by underlying changes in emotional regulation processes and limbic circuitry.

1. DeTore NR, Luther L, Deng W, Zimmerman J, Leathem L, Burke AS, Nyer MB, Holt DJ. Psychol Med. 2023;53:3490-3499.
1. DeTore NR, Burke A, Nyer M, Holt DJ. JAMA Netw Open. 2024;7:e2354728.
1. Holt DJ, Sussman R, Johnson D, Vinke L, Berman T, Zimmerman J, Utter L, Burke A, DeTore NR. Schizophr Bull. 2025.