Summary description: Early Adolescent Skills for Emotions (EASE) is an evidence-based group psychological intervention to help 10–15-year-olds affected by internalizing problems (e.g. stress and symptoms of anxiety, depression) in communities exposed to adversity. Published by the World Health Organization (WHO) and United Nations Children’s Fund (UNICEF), EASE aims to support adolescents and their caregivers with skills to reduce distress.

**Access to the intervention manual: ** Full Open Access

Access to training: The training manual will be open access and available online in 2025. For now, please contact EASEtraining@who.int with any inquiries.

Intended users/ Implementers: Trained and supervised non-specialist provider

Therapeutic strategies: EASE aims to reduce symptoms of internalizing problems in adolescents through four core empirically supported strategies: psychoeducation, stress management, behavioral activation, and problem-solving. The strategies for caregivers include providing psychoeducation and skills to help their children cope with distress, promoting positive parenting skills such as praise and reducing harsh punishment, enhancing communication skills, and strategies for managing caregivers' own stress.

Intervention format: The intervention consists of 7 group sessions for adolescents and 3 additional group sessions for their caregivers. It is based on adapted aspects from Cognitive Behavioral Therapy and has been designed to be suitable for delivery by trained and supervised non-specialist helpers. The EASE intervention manual is accompanied by four additional documents to support its delivery.

Target population: 10–15-year-olds affected by internalizing problems and their caregivers.

Significant effects found on symptoms of: Psychological distress, including child-reported internalizing problems (Jordan and Pakistan), externalizing problems (Pakistan), and attention problems (Pakistan), and a range of other child- and caregiver-reported psychosocial outcomes (Pakistan). It also reduced psychological distress among caregivers (Jordan) and reduced inconsistent disciplinary parenting (Jordan).

Key innovative or differentiating features of this intervention: EASE is comprised of seven weekly 90-minute sessions for adolescents, delivered in groups of approximately 8-12. An intervention manual is used to guide helpers to deliver each session. To maximise engagement, the core strategies are shared through a combination of group teaching, discussion, activities, pictures and drawings, and through a story. Each session includes a welcome and review activity of the previous session’s content, followed by sharing or revising a core skill, and ending with setting home practice to engage in between EASE sessions. The sessions are anchored by an illustrated storybook which depicts a character experiencing common difficulties faced by young people, as the character follows their way through the core EASE strategies. Adolescents are also provided with an illustrated workbook for completing their home practice. For both children and caregivers, EASE has been designed to maximised accessibility in contexts where there is low literacy.

Caregivers of EASE-attending adolescents are invited to participate in three 90-minute caregiver group sessions, delivered to no more than 12 caregivers a group. The purpose of the caregiver sessions is to enhance existing strengths and promote adaptive parenting practices in order to improve the caregiver-child relationship and equip caregivers with skills to support their child living with distress. The caregiver sessions follow a similar approach to the adolescent sessions – with session welcoming and review, imparting of the core content, and closing through setting home practice - using group teaching, pictures and discussion. Caregivers are kept informed about the EASE skills which their children are receiving, without disclosing confidential or personal content about their child’s participation in the group (and vice versa).

The adolescent sessions are structured as follows:

• Understanding my Feelings (core strategy: psychoeducation, including emotion identification)
• Calming my Body (core strategy: stress management, including slow breathing)
• Changing my Actions – part 1, part 2 (core strategy: behavioural activation)
• Managing my Problems – part 1, part 2 (core strategy: problem-solving)
• Brighter futures (maintenance and relapse prevention)

The caregiver sessions are structured as follows:

• Understanding sadness, worry and stress (psychoeducation, active listening, quality time, stress management)
• Boosting confidence (praise, considering children’s strengths, reducing physical punishment)
• Caregiver self-care and brighter futures (caregiver stress management and basic self-care, maintenance and relapse prevention)

EASE sessions are delivered by two trained and supervised non-specialist helpers. Training of helpers consists of at least 80 hours of classroom training, followed by two practice groups and weekly routine supervision by a mental health professional.

Summary of Evidence: EASE has been successfully evaluated in definitive (fully-powered) RCTs among adolescents aged 10 to 15 years and their caregivers in two countries (Jordan and Pakistan).

In Jordan, EASE contributed to reduced internalizing problems among adolescents aged 10-14 years. It also reduced distress among caregivers and improved disciplinary parenting. It did not lead to improvements on other psychosocial outcomes such as externalizing problems and attention problems.

In Pakistan, EASE contributed to reduced internalizing and externalizing problems among adolescents aged 13-15 years. It also improved adolescents’ attention, problem solving and perceived emotional support, and a number of other psychosocial outcomes. The intervention did not improve caregivers’ quality of life or parenting practices.

Requirements / qualifications for trainers and supervisors: Desired profile of a trainer • You are a mental health professional who is competent and experienced in all of the strategies included in EASE. • Ideally, you should first complete the EASE classroom training and the additional training day for supervisors before training others on EASE. o Note that trainers may not be the same persons as those who would deliver supervision, but they often are. Participating in the supervisor training allows future EASE trainers to deliver this part of the training. o In the case you have not completed the EASE classroom training, you should have an in-depth understanding of how to facilitate the EASE intervention and be able to competently demonstrate EASE facilitation skills. More experienced trainers may be able to train EASE without direct experience of delivering EASE groups (e.g. they may have supervised EASE). • You should have experience delivering mental health and psychosocial support services to adolescents and caregivers. o Trainers who do not have direct experience in delivering mental health and psychosocial support services should conduct the classroom training together with someone with a background in mental health (e.g. a mental health professional or social worker) who can provide information and training on addressing the imminent risk of suicide and other immediate safety issues (see Chapter 4 of the EASE intervention manual). • You should be experienced and competent in training and delivering EASE or other non-specialist psychological interventions. • You should possess excellent interpersonal and organizational abilities, and should be able to organize role-plays, manage group discussions, provide feedback and present information in a clear and simple manner. • You should share a common language with trainees or be prepared to use interpretation during the training. • Depending on local policies and laws, you should have qualifications (e.g. being a licensed psychologist) to be a trainer in psychological interventions. Desired profile of a supervisor • Ideally, you should first complete the EASE classroom training and the additional training day for supervisors before supervising helpers to deliver EASE. • You should be able to manage safety issues. • You should be a mental health professional trained in cognitive behavioural therapy (CBT), with experience of supervising manualized psychological interventions in a related culture or context. o Supervisors who do not have a mental health background should have experience of running EASE groups and should be supervised by a mental health professional.

Information provided by Aiysha Malik, Ashley Nemiro and Anne de Graaff on 30 September 2024. They are the authors and editors of the intervention.