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November 29, 2023 at 10:00AM
Study highlights potential adverse effects of universal school-based mental health programs

<p>A study conducted in Australia found that a mental health protection treatment based on Dialectical Behavior Therapy, known as WISE Teens, was ineffective in aiding high school students to improve their emotional well-being and interpersonal relationships. The group that underwent this program experienced deteriorating mental health indicators immediately following the intervention, as opposed to the control group. The study was published in <a href=""><em>Behavior Research and Therapy</em></a>.</p>
<p>Many mental disorders start developing in adolescence. That is the reason why many researchers focus on developing interventions aimed at preventing mental disorders in adolescence and helping adolescents maintain mental health. However, one important topic in this endeavor is that of the method through which such interventions could be delivered. Access to mental health services reaches its lowest point during adolescence and adolescents are often not willing to spend time interacting with mental health service providers.</p>
<p>For this reason, schools are seen by many as an ideal setting for implementing preventative 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 enhance their emotion regulation skills. However, the effectiveness of these universal interventions in school settings has yielded mixed results, with some studies even indicating adverse effects.</p>
<p>Study author Lauren J. Harvey and her team aimed to evaluate the effectiveness of a universal school-based intervention called WISE Teens, which is grounded in the principles of Dialectical Behavior Therapy. Originally developed for treating individuals with borderline personality disorder, Dialectical Behavior Therapy is a cognitive-behavioral approach now used for various mental health conditions. It aims to foster skills in emotion regulation, interpersonal effectiveness, distress tolerance, and acceptance of the present moment. The researchers conducted a quasi-experimental study for this purpose.</p>
<p>The study involved 1071 students in the 8th and 9th grades from two independent and two government high schools in the Sydney metropolitan area, Australia. The average age of the participants was 13-14 years, with 51% being male. In each school, 8th-grade students were assigned to one study group, and 9th-grade students to another. Schools decided which group would receive the intervention and which would serve as the control group.</p>
<p>The intervention program, WISE Teens, included eight weekly sessions adapted from the DBT STEPS-A curriculum, a Dialectical Behavior Therapy program tailored for adolescents. It combines skills training and psychoeducation to address emotional dysregulation, interpersonal issues, and self-destructive behaviors. Each session lasted 50-60 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 with their regular classes.</p>
<p>The study&;s authors conducted assessments at three points: before the intervention, immediately afterward, and six months later. Participants completed a comprehensive set of assessments measuring emotional and behavioral characteristics, resilience, emotion regulation difficulties, stress, depression and anxiety symptoms, emotional awareness, quality of life, and beliefs about emotions. Additionally, those in the intervention group kept weekly diary cards, noting their practice of mindfulness techniques, and six months post-intervention, they reported the frequency of practicing skills learned in WISE Teens.</p>
<p>Contrary to expectations, students who completed the WISE Teens program reported increased overall difficulties and worsened relationships with parents. Their depression and anxiety symptoms also rose slightly after the intervention. Compared to the control group, participants in WISE Teens exhibited heightened emotion dysregulation, reduced emotional awareness, and decreased quality of life. No change was observed in academic resilience. Notably, 13% of WISE Teens participants experienced a significant worsening in depression symptoms post-intervention, compared to 7% in the control group.</p>
<p>In the assessment 6 months after the intervention, most of the differences between the WISE Teens and the control group disappeared. However, the WISE teens group still reported poorer relationships with parents compared to the control group.</p>
<p>“Significantly poorer outcomes were observed immediately following participation in the 8-week DBT-based universal intervention (&;WISE Teens&;) compared with curriculum-as-per-usual. Of concern, the current study is the first to show in the universal intervention literature that both in the immediate and short-term (6-months) such a program may foster significantly poorer quality parent-child relationships relative to curriculum-as-per-usual,&; study authors concluded.</p><div class="addrop-wrap" data-id="64749"><p style="text-align: center;">
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<p>&;There is great enthusiasm for applications of DBT across contexts. However, the current study is a reminder that present enthusiasm for universal dissemination of short-term DBT-based group skills training within schools, specifically in early adolescence, is ahead of the research evidence.&;</p>
<p>While the study contributes significantly to the evaluation of mental health protection treatments, the authors acknowledge that the exact causes of the observed outcomes are unclear, particularly as session attendance was not recorded. Furthermore, all outcome measures were based on self-reports.</p>
<p>The study, “<a href="">Investigating the efficacy of a Dialectical behaviour therapy-based universal intervention on adolescent social and emotional well-being outcomes</a>”, was authored by Lauren J. Harvey, Fiona A. White, Caroline Hunt, and Maree Abbott.</p>
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