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Study highlights potential harmful effects of universal school-based mental health programs

A study in Australia found that a mental health protection treatment based on dialectical behavior therapy, known as WISE Teens, was ineffective in helping high school students improve their emotional well-being and relationships interpersonal. The group that followed this program experienced a deterioration in mental health indicators immediately after the intervention, unlike the control group. The study was published in Behavioral research and therapy.

Many mental disorders begin to develop during adolescence. This is why many researchers focus on developing interventions to prevent mental disorders in adolescence and help adolescents maintain their mental health. However, an important topic in this endeavor is the method by which such interventions might be implemented. Access to mental health services reaches its lowest point during adolescence, and adolescents are often unwilling to spend time interacting with mental health service providers.

It is for this reason that many consider school to be an ideal setting for implementing preventive measures. Mental health interventions in schools are generally designed as universal procedures, targeting all students. They focus more on general risk factors for mental illnesses rather than specific mental health symptoms. A common goal of these interventions is to help students improve their emotion regulation skills. However, the effectiveness of these universal school-based interventions has shown mixed results, with some studies even indicating adverse effects.

Study author Lauren J. Harvey and her team aimed to evaluate the effectiveness of a universal school-based intervention called WISE Teens, based on the principles of dialectical behavior therapy. Originally developed to treat people with borderline personality disorder, dialectical behavior therapy is a cognitive-behavioral approach now used for a variety of mental health problems. It aims to develop skills in emotion regulation, interpersonal effectiveness, distress tolerance and acceptance of the present moment. The researchers conducted a quasi-experimental study for this purpose.

The study included 1,071 grade 8 and 9 students from two independent, public high schools in the Sydney metropolitan area, Australia. The average age of participants was 13 to 14 years old, 51% of whom were male. In each school, 8th graders were assigned to one study group and 9th graders to another. The schools decided which group would benefit from the intervention and which would serve as the control group.

The intervention program, WISE Teens, included eight weekly sessions adapted from the DBT STEPS-A program, a dialectical behavior therapy program tailored to adolescents. It combines professional training and psychoeducation to combat emotional dysregulation, interpersonal problems and self-destructive behaviors. Each session lasted 50 to 60 minutes and covered modules on mindfulness, emotion regulation, distress tolerance, and interpersonal effectiveness. While the intervention group participated in this program, the control group continued their regular classes.

The study authors conducted assessments at three time points: before the intervention, immediately after and six months later. Participants completed a comprehensive set of assessments measuring emotional and behavioral characteristics, resilience, emotion regulation difficulties, symptoms of stress, depression and anxiety, emotional awareness, quality of life and beliefs regarding emotions. Additionally, members of the intervention group kept a weekly journal, noting their practice of mindfulness techniques, and six months after the intervention, they reported the frequency of practicing the skills learned at WISE Teens.

Contrary to expectations, students who completed the WISE Teens program reported an increase in overall difficulties and a deterioration in relationships with their parents. Their symptoms of depression and anxiety also increased slightly after the intervention. Compared to the control group, WISE Teens participants exhibited increased emotional dysregulation, reduced emotional awareness, and reduced quality of life. No changes were observed in academic resilience. Notably, 13% of WISE Teens participants experienced a significant worsening of their depression symptoms after the intervention, compared to 7% in the control group.

When assessed 6 months after the intervention, most differences between the WISE adolescents and the control group disappeared. However, the WISE adolescent group still reported poorer relationships with their parents compared to the control group.

“Significantly poorer outcomes were observed immediately after participation in the 8-week universal DBT-based intervention (“WISE Teens”) compared to the usual program. It is concerning to note that the present study is the first to show in the universal intervention literature that both immediately and in the short term (6 months), such a program can promote parent-child relationships. of much lower quality compared to the curriculum as planned. usual,” the study authors concluded.

“There is great enthusiasm for applications of DBT in all contexts. However, the current study serves as a reminder that current enthusiasm for the universal dissemination of short-term DBT-based group training within schools, particularly in early adolescence, is ahead of research evidence .

Although the study contributes significantly to the evaluation of mental health protective treatments, the authors acknowledge that the exact causes of the observed results are unclear, especially since attendance at the sessions was not been recorded. Additionally, all outcome measures were based on self-reports.

The study, “Investigating the Effectiveness of a Universal Intervention Based on Dialectical Behavior Therapy on Adolescent Social and Emotional Well-Being Outcomes,” was authored by Lauren J. Harvey, Fiona A. White , Caroline Hunt and Maree Abbott.

Gn Health

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