Research has focused on early intervention to allow adolescents to realize the best possible outcomes when it comes to mental health. One way to deliver preventive interventions is through the school system, where adolescents spend much of their days. Outcomes of preventive mental health interventions in schools have been mixed, and some studies have shown adverse effects of such interventions. It is possible, for example, that translating interventions from one context (patients in the therapy office) to another (a general student population in schools) may have unintended consequences. In this study, Harvey and colleagues introduced a dialectical behaviour therapy (DBT) skills program within the school curriculum. Almost 1100 students were allocated to groups within schools to receive the intervention or to a control condition. The students were in grades 8 and 9, with an average age of 13.48 (SD = 0.70). The “Wise Teens” intervention consisted of 8-weekly 50-minute sessions with a manualized protocol of four DBT training modules: mindfulness, emotion regulation, distress tolerance, and interpersonal effectiveness. Students were encouraged to practice at home and review the homework practice at the subsequent session. The sessions were led by one or two experienced facilitators who were post-graduate trainee clinical psychologists (doctoral or master level). Adolescent participants in the control condition attended their usual Health and Physical Education classes. Immediately post-intervention, contrary to predictions, participants in the “Wise Teens” condition reported significantly worse total difficulties, (t(2485.65) = -2.70, p = .007; d = -0.12; 95% CI -0.26, -0.02), significantly poorer quality of mother-child relationships, (t(1813.16) = 3.18, p = .002; d = 0.15; 95% CI 0.01, 0.30), and significantly poorer quality of father-child relationships (t(1640.99) = 3.15, p = .002; d = 0.16; 95% CI = 0.01, 0.32). Those who received the “Wise Teens” intervention also reported increases in depression, anxiety, and emotional dysregulation, and lower emotional awareness and quality of life compared to the control group. The effect sizes in most cases tended to be small, and most differences disappeared at the six-months follow-up except for the quality of the relationship with mother and father. Only 30% of adolescents undertook the home practice throughout the intervention.
This study and others like it demonstrate how complicated it is to take psychological therapy principles and apply them as a preventive measure to the general population of adolescents. The findings raise concerns about the potential harm of such universal interventions. Universally applied interventions should consider the participants' developmental needs and the school system's needs.
Harvey, L.J., White, F.A., Hunt, C., Abbott, M. (2023). Investigating the efficacy of a Dialectical behaviour therapy-based universal intervention on adolescent social and emotional well-being outcomes. Behaviour Research and Therapy, 169. https://doi.org/10.1016/j.brat.2023.104408.