Aniek Wols

14 Chapter 1 De Graaf et al., 2010; Garber et al., 2002; Ge et al., 1994; Larson & Ham, 1993; Meijer et al., 2006). Regarding underlying mechanisms, both anxiety and depression are characterised by cognitive biases such as negative automatic thoughts, maladaptive beliefs and behaviours, negative affect, elevated distress and dysfunctional emotions (Calvete et al., 2013; Chu & Harrison, 2007; Cole et al., 2008; Dozois et al., 2009; Ehring & Watkins, 2008; Farchione et al., 2012; Harvey et al., 2004; McEvoy et al., 2013; Muris et al., 2005; Trosper et al., 2012). Moreover, clinical reliability in distinguishing anxiety and depression from one another has proven to be low (T. A. Brown et al., 2001). Taking this into account, as well as the fact that anxiety and depression share similar underlying mechanisms and cognitive processes, prevention efforts often focus on transdiagnostic mechanisms underlying both anxiety and depression, which potentially also lead to a larger benefit of prevention programs (Chu et al., 2015; Dozois et al., 2009). Most prevention programs for anxiety and depression include elements of cognitive behavioural therapy (CBT) (Butler et al., 2006; Kendall, 2011; Mychailyszyn et al., 2012), which aims to address and target the underlying mechanisms associated with anxiety and depression (Calvete et al., 2013; Chu & Harrison, 2007; Cole et al., 2008). CBT is designed to focus on the interplay between thoughts, feelings, and behaviours, and to practice adaptive responses to difficult events (Compton et al., 2004). Individuals learn to identify, challenge and replace dysfunctional or negative thoughts with more adaptive thoughts and behaviours (Beck, 2005; Nolen-Hoeksema, 2001). CBT-based prevention programs typically include various therapeutic techniques, such as problemsolving skills, cognitive restructuring, family communication skills training, exposure therapy, pleasant activity scheduling, and behavioural activation (Compton et al., 2004; Kendall, 2011). These techniques help individuals develop effective coping skills and challenge negative thinking patterns, with the goal to improve negative affect, decrease distress and increase cognitive coping, subsequently reducing symptoms and the risk of developing an anxiety or depressive disorder (Calvete et al., 2013; Chu & Harrison, 2007; Cole et al., 2008; Sander & McCarty, 2005). LIMITATIONS AND BARRIERS OF CONVENTIONAL PREVENTION PROGRAMS Although CBT-based prevention programs are widely used and several meta-analyses have found them to be effective in reducing symptoms and

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