Goal setting with young people for anxiety and depression: What works for whom in therapeutic relationships? A literature review and insight analysis

Background Goal setting and goal-focused work is widely used in young people’s mental health settings. However, little is known about how, why or for whom this is helpful. This study aims to explore the mechanisms of collaborative goal setting as part of therapeutic relationships: is it helpful for young people experiencing anxiety and/or depression, how and why/not, for whom, and under what circumstances? Methods Online database searches generated 10,907 records. Seven unique studies are included, combined with insight analysis from directed discussions with international advisors with lived experience of anxiety and/or depression and therapy (N = 8; mean age = 20.8), and mental health academics/clinicians (N = 6). Results Findings are presented as a narrative synthesis and suggest that goal setting is helpful to young people experiencing anxiety and/or depression because it helps build good therapeutic relationships through open communication and building trust. Goal setting helps make things more manageable, enabling young people to feel supported and have ownership of their care. Individual preferences, or high levels of distress, trauma, low confidence, hopelessness, negative past experiences of goal setting, perfectionism, and rumination are considered limiting factors to goal setting. Additionally, contextual factors including country and long-term therapy are explored. Conclusion Whilst the resultant sample is small, emphasis on the voices of young people in the research is both prominent and of paramount importance. Several key literature gaps are identified, including evidenced links to the reduction in symptoms. Priority must be given to researching unhelpful mechanisms of goal setting for young people experiencing anxiety and/or depression, to avoid any potential iatrogenic effects. Supplementary Information The online version contains supplementary material available at 10.1186/s40359-022-00879-5.


Intervention/Moderator (Goals)
Focus on goals; discussion of setting goals or goal-focused working No focus on goals Condition (Mental health) Anxiety (as defined) Depression (as defined) Non-mental health. Mental health not including anxiety and depression.

Outcome (Therapeutic Alliance
Or or general views on goal setting (e.g., perspective, view, narrative)).
Focus on the working relationship between practitioners and young people, especially as a conduit to better outcomes as defined by young people No mention of working relationships, shared decision making etc.
No exploration of the benefits/disbenefits of goals Study type All study types will be considered, e.g., narrative reviews, commentaries, narrative case studies, RCTs, surveys, naturalistic studies None.
*Search term was removed from the search terms due to anticipated limitations of accessing relevant literature, e.g., the term "young people" would not capture those in the upper end of the age range. Inclusion and exclusion criteria were applied at the filtering stage

a) MEDLINE
((Depression or (Anxiety or Anxiety Disorders) or Mood Disorders or (psychological trauma or sexual trauma or stress disorders, post-traumatic or stress disorders, traumatic, acute) or Psychological Distress) and ((task* adj2 (behavio* or mental health)) or (target* adj2 (behavio* or mental health)) or (aim* adj2 (behavio* or mental health)) or ("personal project*" adj2 (behavio* or mental health)) or (striving* adj2 (behavio* or mental health)) or (plan* adj2 (behavio* or mental health)) or (goal* adj5 (set* or agree* or plan* or consensus or negotiat* or discuss* or propos* or develop* or formulat* or elaborat* or establish* or identif* or write or written or state* or specif* or construct* or manag* or direct* or orient* or attain* or achiev* or evaluat* or cent?red or focus* or track* or progress*))) and (perspective* or view* or percept* or narrative* or opinion* or barrier* or facilitator* or strength* or weakness* or concern* or understand* or judg* or catalyst* or obstacle* or feedback* or outcome* or (therapeutic alliance or Decision Making, Shared or (communication or negotiating) or (Interaction* or Relation* or Partner* or Agreement* or Disagreement* or engag* or disengag* or rapport or collab*)))).ti,ab. limit 23 to (english language and yr="2000 -Current")

b) PsycInfo
((Depression or (Anxiety or Anxiety Disorders) or Mood Disorders or (psychological trauma or sexual trauma or stress disorders, post-traumatic or stress disorders, traumatic, acute) or Psychological Distress) and ((task* adj2 (behavio* or mental health)) or (target* adj2 (behavio* or mental health)) or (aim* adj2 (behavio* or mental health)) or ("personal project*" adj2 (behavio* or mental health)) or (striving* adj2 (behavio* or mental health)) or (plan* adj2 (behavio* or mental health)) or (goal* adj5 (set* or agree* or plan* or consensus or negotiat* or discuss* or propos* or develop* or formulat* or elaborat* or establish* or identif* or write or written or state* or specif* or construct* or manag* or direct* or orient* or attain* or achiev* or evaluat* or cent?red or focus* or track* or progress*))) and (perspective* or view* or percept* or narrative* or opinion* or barrier* or facilitator* or strength* or weakness* or concern* or understand* or judg* or catalyst* or obstacle* or feedback* or outcome* or (therapeutic alliance or Decision Making, Shared or (communication or negotiating) or (Interaction* or Relation* or Partner* or Agreement* or Disagreement* or engag* or disengag* or rapport or collab*)))).ti,ab. limit 2 to (english language and yr="2000 -Current")

c) EMBASE
((Depression or (Anxiety or Anxiety Disorders) or Mood Disorders or (psychological trauma or sexual trauma or stress disorders, post-traumatic or stress disorders, traumatic, acute) or Psychological Distress) and ((task* adj2 (behavio* or mental health)) or (target* adj2 (behavio* or mental health)) or (aim* adj2 (behavio* or mental health)) or ("personal project*" adj2 (behavio* or mental health)) or (striving* adj2 (behavio* or mental health)) or (plan* adj2 (behavio* or mental health)) or (goal* adj5 (set* or agree* or plan* or consensus or negotiat* or discuss* or propos* or develop* or formulat* or elaborat* or establish* or identif* or write or written or state* or specif* or construct* or manag* or direct* or orient* or attain* or achiev* or evaluat* or cent?red or focus* or track* or progress*))) and (perspective* or view* or percept* or narrative* or opinion* or barrier* or facilitator* or strength* or weakness* or concern* or understand* or judg* or catalyst* or obstacle* or feedback* or outcome* or (therapeutic alliance or Decision Making, Shared or (communication or negotiating) or (Interaction* or Relation* or Partner* or Agreement* or Disagreement* or engag* or disengag* or rapport or collab*)))).ti,ab. limit 2 to (english language and yr="2000 -Current")

e) Cochrane Library of Systematic Reviews
(Depression or (Anxiety or Anxiety Disorders) or Mood Disorders or (psychological trauma or sexual trauma or stress disorders, post-traumatic or stress disorders, traumatic, acute) or Psychological Distress):ti,ab,kw AND ((perspective* or view* or percept* or narrative* or opinion* or barrier* or facilitator* or strength* or weakness* or concern* or understand* or judg* or catalyst* or obstacle* or feedback* or outcome*) or (therapeutic alliance or Decision Making, Shared or (communication or negotiating)) or (Interaction* or Relation* or Partner* or Agreement* or Disagreement* or engag* or disengag* or rapport or collab*)):ti,ab,kw AND ((task or target or aim* or "personal project" or striving* or plan* or goal*)):ti,ab,kw f) ERIC AB ((Depression or (Anxiety or Anxiety Disorders) or Mood Disorders or (psychological trauma or sexual trauma or stress disorders, post-traumatic or stress disorders, traumatic, acute) or Psychological Distress) and (perspective* or view* or percept* or narrative* or opinion* or barrier* or facilitator* or strength* or weakness* or concern* or understand* or judg* or catalyst* or obstacle* or feedback* or outcome* or (therapeutic alliance or Decision Making, Shared or (communication or negotiating) or (Interaction* or Relation* or Partner* or Agreement* or Disagreement* or engag* or disengag* or rapport or collab*)) and ( (task* N2 (behavio* or mental health) ) OR AB ( (target* N2 (behavio* or mental health) ) OR AB ( (aim* N2 (behavio* or mental health) ) OR AB ( ("personal project*" N2 (behavio* or mental health) ) OR AB ( (striving* N2 (behavio* or mental health) ) OR AB ( (plan* N2 (behavio* or mental health) ) OR (goal* N5 (set* or agree* or plan* or consensus or negotiat* or discuss* or propos* or develop* or formulat* or elaborat* or establish* or identif* or write or written or state* or specif* or construct* or manag* or direct* or orient* or attain* or achiev* or evaluat* or cent?red or focus* or task* or progress*)).

g) CINAHL Plus
AB ((Depression or (Anxiety or Anxiety Disorders) or Mood Disorders or (psychological trauma or sexual trauma or stress disorders, post-traumatic or stress disorders, traumatic, acute) or Psychological Distress) and (perspective* or view* or percept* or narrative* or opinion* or barrier* or facilitator* or strength* or weakness* or concern* or understand* or judg* or catalyst* or obstacle* or feedback* or outcome* or (therapeutic alliance or Decision Making, Shared or (communication or negotiating) or (Interaction* or Relation* or Partner* or Agreement* or Disagreement* or engag* or disengag* or rapport or collab*)) and ( (task* N2 (behavio* or mental health) ) OR AB ( (target* N2 (behavio* or mental health) ) OR AB ( (aim* N2 (behavio* or mental health) ) OR AB ( ("personal project*" N2 (behavio* or mental health) ) OR AB ( (striving* N2 (behavio* or mental health) ) OR AB ( (plan* N2 (behavio* or mental health) ) OR (goal* N5 (set* or agree* or plan* or consensus or negotiat* or discuss* or propos* or develop* or formulat* or elaborat* or establish* or identif* or write or written or state* or specif* or construct* or manag* or direct* or orient* or attain* or achiev* or evaluat* or cent?red or focus* or task* or progress*)).

h) Child Development & Adolescent Studies
AB ((Depression or (Anxiety or Anxiety Disorders) or Mood Disorders or (psychological trauma or sexual trauma or stress disorders, post-traumatic or stress disorders, traumatic, acute) or Psychological Distress) and (perspective* or view* or percept* or narrative* or opinion* or barrier* or facilitator* or strength* or weakness* or concern* or understand* or judg* or catalyst* or obstacle* or feedback* or outcome* or (therapeutic alliance or Decision Making, Shared or (communication or negotiating) or (Interaction* or Relation* or Partner* or Agreement* or Disagreement* or engag* or disengag* or rapport or collab*)) and ( (task* N2 (behavio* or mental health) ) OR AB ( (target* N2 (behavio* or mental health) ) OR AB ( (aim* N2 (behavio* or mental health) ) OR AB ( ("personal project*" N2 (behavio* or mental health) ) OR AB ( (striving* N2 (behavio* or mental health) ) OR AB ( (plan* N2 (behavio* or mental health) ) OR (goal* N5 (set* or agree* or plan* or consensus or negotiat* or discuss* or propos* or develop* or formulat* or elaborat* or establish* or identif* or write or written or state* or specif* or construct* or manag* or direct* or orient* or attain* or achiev* or evaluat* or cent?red or focus* or task* or progress*)). Limiters -Date Published: 20000101-20210631 Expanders -Apply related words; Apply equivalent subjects Search modes -Boolean/Phrase