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March 15, 2022

Research Study on Cognitive Behavioural Therapy as part of the School Curriculum

Written and researched by Lynda Fraser February 2022

Abstract:

Cognitive Behavioural Therapy can be an effective mental health resource for adolescents and teachers. For example, previous research shows that self-isolation during the Covid Pandemic created adverse mental health outcomes in adolescents resulting in a need to research additional programs or resources to assist adolescents with their mental health. Therefore, Cognitive Behavioural Therapy (CBT) will be investigated as a resource to manage students’ mental health, specifically depression.  In addition, the Center for Epidemiological Studies Depression Scale for Children will be given to the students before the CBT sessions and then again after the CBT sessions to compare the participant’s level of depression. The study results would indicate that CBT as a resource taught in their school curriculum would be beneficial in improving the participant’s levels of depression. Therefore, a further recommendation would be that CBT or another modality should become a required course in schools to address escalating mental health issues amongst adolescents.

Introduction:

Increases in adolescent mental health have been a growing concern for many years. Consequently, during the Covid-19 pandemic, students were faced with online learning, generating a surge in adolescents with mental health issues such as depression and anxiety due to long periods of isolation (Elharake et al., 2021). The study of Wright & Wachs (2021) was the basis for investigation. Wright and Wachs (2021) revealed that feelings of self-isolation during the Covid Pandemic created adverse mental health outcomes in adolescents and concluded the need to research programs or resources to assist adolescents with their mental health, specifically Cognitive Behavioural Therapy. Wright and Wachs (2021) indicated offering CBT as a school-based program or resource from a healthcare provider or certified teacher. Although the online learning option, for many, was their only connection to the outside world for months, this was often not beneficial. As a result, adolescent mental health is now reaching a critical concern for public health.

According to the World Health Organization (WHO 2012), 10–19-year-old adolescents account for 20% of mental health conditions globally, with depression at the top. Furthermore, about 50% of mental health disorders will start during adolescence, with 70% to 80% of these illnesses going untreated (Mei et al. 2020). Unfortunately, various factors such as social and economic statuses, parental support, and living in rural areas limit access to commonly known treatments, such as (in-person) therapy for adolescent mental health. In addition, due to the Covid-19 pandemic, adolescent mental health numbers have drastically risen (Elharake et al., 2021). Adolescents are experiencing long periods of isolation during quarantine, physically separating them from their friends, extended family members, and teachers and forcing them to adapt to new ways of learning and socialization. Many students who have not been equipped with acceptable technology to do their virtual learning and stay in contact with friends and family have experienced heightened loneliness, boredom, and frustration (Elharake et al., 2021). This sets these students on a course for additional mental and physical health complications in their adult life. Therefore, access to universal mental health resources and programs to assist adolescents during their crucial developmental period would be beneficial. Incorporating CBT into a school curriculum would be a valuable resource that could be used to improve the mental health of students and teachers during difficult times such as the Covid-19 Pandemic. CBT is an evidence-based intervention that is effective for many mental health problems. Unfortunately, many schools have little or no mental health programs or resources available in their school curriculum. This may be because few studies have been researched into implementing mental health resources into academic settings. Investigating a mental health resource such as CBT into the school curriculum is essential and timely due to the current world pandemic and the volatile state of adolescent mental health. 

Literature Review:   

Fourteen relevant studies on adolescent mental health and CBT for depressed adolescents were reviewed for this report. These studies display the increasing need for accessible adolescent mental health resources and suggest implementing a resource into the school curriculum. A global research group created in 2016 called the International Youth Mental Health Research Network (IYMHRN) focuses on adolescent mental health prevention and programmes. The IYMHRN consisted of a steering committee and approximately 130 mental health researchers to consult adolescents experiencing mental illness and develop psychosocial resources and support (Mei et al. 2020). 

However, according to Zolkoski & Bullock (2012), adolescents who experience multiple or traumatic hardships may negatively impact their mental well-being and leave the individual, resulting in maladaptive behaviours. 

The current Covid-19 Pandemic has drawn attention to the need to provide psychosocial support and mental health programs for adolescents. With closures of educational institutions due to the coronavirus disease (COVID-19), many schools were forced to provide eLearning formats at the start of the pandemic, requiring students and their families to self-isolate within their homes. Unfortunately, much of the literature has revealed that adolescents suffer adverse mental effects from prolonged self-isolation (Wright & Wachs 2021), which causes depression, anxiety, and psychological distress (Elharake et al. 2021). Wright and Wachs (2021) recently completed research on ‘Self-isolation during the beginning of the COVID-19 pandemic and health outcomes of adolescents.’ They examined the effect of perceived teacher support during the self-isolation period at the beginning of the COVID-19 pandemic. The study involved 467 students aged 12 to 15 years old who lived in large cities throughout the United States. Students (and their parents) completed electronic tests at the initial isolation period, April 2020 and again at the end of May 2020. Wright and Wachs’ (2021) findings revealed that teachers who offered more significant virtual support to their students had fewer adverse mental health issues due to self-isolation.

By contrast, minimal teacher support during self-isolation increased the possibility of suicidal ideation, depression and adverse health outcomes. The students define teacher support as knowing they are significant, respected and have a caring and reliable social network. These results indicate the need for mental health resources for students and the importance of educating teachers on their significant role during virtual learning (Wright & Wachs 2021). Similar learning perspectives would be expected for the in-person learning results, as demonstrated in Vaillancourt et al.’s (2022) research. Their research on ‘In-person Learning Versus Online Learning and Students’ Perception of Mattering During Covid-19′ discovered that students who attended school in-person felt they were more significant versus students who learned online. Therefore, they may experience better mental health and emotional well-being (Vaillancourt et al., 2022). However, many students and family’s only option was online learning due to the high risk of acquiring COVID-19 and the closure of their schools. In addition, online learning offered few occasions for students to interact freely with their peers and teachers, and they were often unable to ask questions or for help. The study by Aldridge, J., & McChesney, K., (2018) on how school climate directly affects student mental health addressed the fact that a great deal of lifetime mental health issues starts during adolescence. Therefore, due to the amount of time children spend in school, it would be advantageous to institute school programs that offer early prevention and intervention regarding the mental well-being of children (Aldridge & McChesney, 2018). One intervention recently studied and used in child care centers is the early childhood mental health consultation or ECMHC (Elharake et al., 2021). This preventative intervention has shown a significant reduction in hyperactivity, restlessness, and problem behaviours in children under six years, along with significant positive impacts on prosocial behaviours. It was also suggested that healthcare providers could offer preventative support and early interventions.

As mentioned, offering general support programs may be a solution but may not be sufficient. For example, many students may not have access to technology if these programs are technology-based, in-person programs during after-school hours may be inaccessible to rural students, and private support programs may be too costly. Therefore, investing in preventative health care that provides students with the knowledge and coping techniques on mental health would be successful if taught within the school learning platform. (Das et al., 2016). For example, Das et al. (2016) did a systemic review on 28 school-based prevention and intervention programs. These school-based programs were based on cognitive behavioural therapy (CBT) and overall reduced depression and anxiety by 95%. Implementing CBT into schools could be offered to teachers as professional development and then taught to the students or taught directly to students by a health professional or graduate students presented over a series of sessions. Therefore, teaching CBT in schools would successfully reduce symptoms of depression and anxiety (Das et al., 2016). 

Another program called the MoodGYM was implemented in select schools in Australia. It was an online interactive and self-directed cognitive behavioural program (Calear et al., 2009). This program was created for adolescents to decrease or prevent symptoms of depression and anxiety. MoodGYM is based on CBT and intends to change negative beliefs and thoughts into positive ones, improve self-esteem and interpersonal relationships, and learn essential life skills. The results were beneficial in significantly lowering anxiety symptoms, more so in the face-to-face teacher-delivered study versus the internet-delivered program (Calear et al., 2009). 

In the book Cognitive Behavioral Therapy in Schools, A Tiered Approach to Youth   Mental Health Services, by Raffaele-Mendez, L. (2016), the author provides an overview of US schools’ seriously declining mental health situation. Raffaele-Mendez, L. (2016) demonstrates the effectiveness of a three-tiered Social Mental Health (SMH) approach using CBT. Raffaele-Mendez documented two school case studies in Florida, U.S.A. and another in New York, U.S.A., who used the CBT tiered system with great success. Of course, the ideal would be to implement an SMH program, such as CBT in schools, that students could use as a preventative or resource during difficult mental health periods. 

Method

Hypothesis: Based on statistical results, developing effective and reliable mental health resources and programs, such as cognitive behavioural therapy, should be incorporated in school curriculums to meet the needs of rising mental health concerns in adolescents.

Cognitive Behavioural Therapy is becoming the therapy of choice for medical practitioners referring patients struggling with certain destructive behaviours. It is a well-recognized training system for patients to identify and reconstruct specific negative thought processes affecting their lives and, in many cases, is more effective than medication., A  person’s distorted thinking pattern can bring an altered view of the world, which can cause feelings of depression, anxiety, and anger. As a result, CBT is a tremendously valuable tool that can realign one’s poor thought patterns and improve the sufferer’s life in the long term, including those who may also suffer from OCD, PTSD, and ADHD. CBT is very accessible, at a cost people can afford. CBT is a here-and-now therapy, and many succeed with it.

Results

Initial survey results should show that both groups would indicate that most participants would score above 15, thus displaying symptoms of depression. Moreover, after Group B completed the CBT sessions and completed the CES-DC depression form, most should score below 15, improving their mental health. Therefore we would conclude that CBT is a tangible resource for depression or improving adolescent mental health such as depression. In addition, we would want to reflect on these results to show how CBT could be instituted as a resource in schools for the prevention and intervention of mental illnesses. 

Discussion:

Concerns regarding the results, since the surveys are anonymous, it will be impossible to determine if an individual’s score above or below 15 pre-survey were changed post-survey; therefore, we will have to conclude the results based on the total number of participants in each category. In addition, some of the 25 participants from Group B may not finish their CBT sessions due to cognitive dissonance (resisting CBT as a treatment), the length of the study being 8-10 weeks or not committed to doing the homework involved in improving their mental health. Another concern may be that outside events may prevent participants from continuing, such as illness (Covid), family or personal issues, or other issues.

In conclusion, CBT’s positive effect on adolescents’ mental health would be advantageous as a resource, with a recommendation to be offered in schools. Students spend a great deal of time in school. Therefore, mental health and mental health resources should be factored into their curriculum so it does not involve any additional time outside of school, thus creating any undue stress. 

References:

Aldridge, J., McChesney, K., (2018), The relationships between school climate and adolescent mental health and well-being: A systematic literature review, International Journal of Educational Research 88, 121-145 https://doi.org/10.1016/j.ijer.2018.01.012

Calear, A L., Christensen, H., MacKinnon A., Griffiths, K., O’Kearney, R., (2009), The YouthMood Project: A cluster Randomized Controlled Trial of an Online Cognitive Behavioural Program with Adolescents: Peer Reviewed Journal 55. https://dx.doi.org/10.1037/a0017391

Das, J. K., Salam, R. A., Lassi, Z. S., Khan, M. N., Mahmood, W., Patel, V., & Bhutta, Z. A. (2016). Interventions for Adolescent Mental Health: An Overview of Systematic Reviews. Journal of Adolescent Health59(4), S49–S60. https://doi.org/10.1016/j.jadohealth.2016.06.020

Elharake, Jad., Akbar, F., Malik, A., Gilliam, W., Omar, S., (2021). Mental Health Impact of COVID-19 among Children and College Students: A Systematic Review. Child Psychiatry & Human Development, https://doi.org/10.1007/s10578-021-01297-1

Faulstich ME, Carey MP, Ruggiero L, et al. (1986). Assessment of depression in childhood and adolescence: An evaluation of the Center for Epidemiological Studies Depression Scale for Children (CES-DC). American Journal of Psychiatry 143(8):1024–1027.   https://doi.org/10.1176/ajp.143.8.1024

García-Carrión, R., Villarejo-Carballido, B., & Villardón-Gallego, L. (2019). Children and Adolescents Mental Health: A Systematic Review of Interaction-Based Interventions in Schools and Communities. Frontiers in psychology10, 918. https://doi.org/10.3389/fpsyg.2019.00918

Joyce-Beaulieu, D., & Zaboski, B. (2021). Applied Cognitive Behavioral Therapy in Schools.  Oxford University Press. https://doi.org/10.1093/med-psych/9780197581384.003.0001

Mei, C., Fitzsimons, J., Allen, N., Alvarez‐Jimenez, M., Amminger, G. P., Browne, V., Cannon, M., Davis, M., Dooley, B., Hickie, I. B., Iyer, S., Killackey, E., Malla, A., Manion, I., Mathias, S., Pennell, K., Purcell, R., Rickwood, D., Singh, S. P.,  McGorry, P. D. (2020). Global Research Priorities for Youth Mental Health. Early Intervention in Psychiatry14(1), 3–13https://doi.org/10.1111/eip.12878

Raffale Mendez, L.M. (2016). Cognitive Behavioral Therapy in Schools: A Tiered Approach to Youth Mental Health Services (1st ed.). Routledge. https://0-doi.org.serlib0.essex.ac.uk/10.4324/9781315694399

Tanhan, A., Yavuz, K. F., Young, J. S., Nalbant, A., Arslan, G., Yıldırım, M., Ulusoy, S., Genç, E., Uğur, E., & Çiçek, İ. (2020). A Proposed Framework Based on Literature Review of Online Contextual Mental Health Services to Enhance Wellbeing and Address Psychopathology During COVID-19. Electronic Journal of General Medicine, 17(6), 254. https://doi.org/10.29333/ejgm/8316

Vaillancourt, T., Brittain, H., Krygsman, A., Farrell, A. H., Pepler, D., Landon, S., Saint-Georges, Z., & Vitoroulis, I. (2022). In-Person Versus Online Learning in Relation to Students’ Perceptions of Mattering During COVID-19: A Brief Report. Journal of Psychoeducational Assessment, 40(1), 159–169. https://doi.org/10.1177/07342829211053668

Wright, M. F., & Wachs, S. (2021). Self-isolation during the beginning of the COVID-19 pandemic and adolescents’ health outcomes: The moderating effect of perceived teacher support. School Psychologyhttps://doi.org/10.1037/spq0000460

World Health Organization (2012, June 12). Adolescent mental health: mapping actions of nongovernmental organizations and other international development organizations. https://www.who.int/publications/i/item/adolescent-mental-health

Zolkoski, S., Bullock, L., (2012), Resilience in Children and Youth: A Review. Children and Youth Services Review, 34(12), 2295-2303 https://dx.doi.org/10.1016/j.childyouth.2012.08.009



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