Home > Mental health and young people: a review of CBT-based interventions.

Keane, Martin (2010) Mental health and young people: a review of CBT-based interventions. Drugnet Ireland, Issue 32, Winter 2009, p. 22.

PDF (Drugnet Ireland, issue 32) - Published Version

The recently published results of a systematic review shed some light on what works in reducing or preventing mental health problems among young people.1 One of the questions addressed in the review was:  

Are secondary school-based mental health interventions based on cognitive behavioural techniques effective in preventing or alleviating depression, anxiety and suicidality among young people?
Following an extensive search of a number of relevant databases, repeated screening of thousands of studies and an assessment of the quality of potential studies for synthesis, 17 randomised controlled trials (RCTs) were included in the final synthesis. All the interventions were based on techniques derived from cognitive behavioural therapy (CBT), and were delivered to either small groups or entire classes. The authors point out that the CBT approach is primarily based on Beck’s cognitive model of depression, which focuses primarily on the relationships between cognitions, feeling and behaviours.2
All the studies included in the review evaluated CBT interventions for effectiveness in reducing or preventing the onset of the symptoms of a range of emotional disorders. None presented data on the impact of CBT interventions on suicidal thoughts or behaviours, and none stated that suicide prevention had been an explicit aim of the intervention. The interventions taught students a variety of techniques for problem solving and coping, including assertiveness training, relaxation, negotiation, positive thinking and communication. Interventions aimed at reducing anxiety focused on social skills training.
Findings on effectiveness of CBT interventions
Impact of CBT on depression outcomes
CBT interventions were effective in reducing depressive symptoms up to three months after the intervention had finished. The effect remained positive, although insignificant, at six- and twelve-month follow-up. Universal interventions were shown to improve depressive symptoms up to four weeks after delivery. Indicated interventions were shown to improve depressive symptoms up to six months after delivery. No evidence of harm was detected in any of the analysis. Interventions delivered by a member of school staff were found to be effective, while those delivered by external providers were not. Interventions of 10 or more sessions were effective up to three months post intervention. Shorter interventions, up to nine sessions, were found to be ineffective.
Impact of CBT on anxiety outcomes
CBT interventions were found to be effective in reducing anxiety immediately post intervention, and at six-month follow-up. There was insufficient data to evaluate the effectiveness of interventions delivered by internal school staff. Interventions delivered by external providers were not shown to be effective in reducing anxiety. Interventions of up to nine sessions were effective at six-month follow-up. Interventions of 10 sessions or more were found to be effective immediately post-intervention.
Recommendations for practice
The authors make a number of recommendations that may be useful to those wishing to implement preventive mental health programmes in secondary schools. Providers should consider the use of CBT-based interventions for reducing depression and anxiety levels. Given the uncertainties about the long-term benefits of universal interventions, efforts to prevent depression in young people might best be directed towards indicated interventions. Providers of preventive mental health services to young people should:
·       consider using adequately trained and supported school staff to provide CBT-based interventions to young people;
·       consider providing programmes of 10 or more weeks’ duration; and
·       be aware of, and consider monitoring, potential adverse effects (i.e. stigma associated with mental health problems).
Providers of preventive mental health services to young people who are considering providing universal, rather than indicated, interventions should evaluate the impact of the intervention on high- and low-risk groups. Providers implementing indicated interventions may wish to monitor any potential adverse effects due to stigma associated with mental health problems. While no studies of indicated prevention reported adverse outcomes, such as bullying, The authors warn of ‘the potential risk that participants identified as receiving such interventions may suffer adversely due to the social stigma attached to suffering from an emotional or mental health problem’.
1. Kavanagh J, Oliver S, Caird J, Tucker H, Greaves A, Harden A et al. (2009) Inequalities and the mental health of young people: a systematic review of secondary school-based cognitive behavioural interventions. London: University of London, EPPI-Centre.
2. Beck AT (1974) The development of depression: a cognitive model. In: Friedman R and Katz M (eds) Psychology of depression: contemporary theory and research. Washington, DC: Winston-Wiley. pp. 3–27.

Repository Staff Only: item control page