The Critical Need for Help-Seeking Controls in Clinical High-Risk Research

Zachary B. Millman*, James M. Gold, Vijay A. Mittal, Jason Schiffman

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

20 Scopus citations


Despite rapidly growing knowledge of the clinical high-risk (CHR) state for psychosis, the vast majority of case-control studies have relied on healthy volunteers as a reference point for drawing inferences about the CHR construct. Researchers have long recognized that results generated from this design are limited by significant interpretive concerns, yet little attention has been given to how these concerns affect the growing field of CHR research. We argue that overreliance on healthy control participants in CHR research threatens the validity of inferences concerning group differences, hinders advances in understanding the development of psychosis, and limits clinical progress. We suggest that the combined use of healthy and help-seeking (i.e., psychiatric) controls is a necessary step for the next generation of CHR research. We then evaluate methods for help-seeking control studies, identify the available CHR studies that have used such designs, discuss select findings in this literature, and offer recommendations for research.

Original languageEnglish (US)
Pages (from-to)1171-1189
Number of pages19
JournalClinical Psychological Science
Issue number6
StatePublished - Nov 1 2019


  • clinical high-risk
  • development
  • etiology
  • psychosis
  • research design
  • transdiagnostic

ASJC Scopus subject areas

  • Clinical Psychology


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