Stress workshop in UK schools significantly improves mental health of teenagers

By Danielle Ellis, B.Sc.May 19 2024Reviewed by Benedette Cuffari, M.Sc.

Adolescence can be a period of intense mental stress, which increases the risk of both anxiety and depression in this age group. To mitigate this trend, schools in the United Kingdom have assessed the efficacy of a stress workshop program targeting young people between 16 and 18 years of age.

This program was part of an investigation under the Brief Educational Workshops in Secondary Schools Trial (BESST). The results of BESST were recently published in The Lancet, wherein researchers report the clinical and cost-effectiveness of the workshop at six months as compared to standard treatment.

Study: Clinical effectiveness and cost-effectiveness of a brief accessible cognitive behavioral therapy programme for stress in school-aged adolescents (BESST): a cluster randomised controlled trial in the UK. Image Credit: SeventyFour / Shutterstock.com

Mental health care in adolescence

Over 50% of mental health disorders in adults manifest before the age of 15, with 75% of these issues developing by 18 years of age. Over 25% of individuals between 17 and 19 years of age were estimated to have a mental health disorder in 2022, which increased from 17% in 2021. Moreover, approximately 60% of children and adolescents with clinically diagnosable mental health disorders in the U.K. do not receive specialist care through the Child and Adolescent Mental Health Services (CAMHS).

Some evidence suggests that specialist cognitive behavioral therapy (CBT) could be more effective than other interventions, particularly for older adolescents whose brains are rapidly maturing, sleep patterns are changing, and coping mechanisms are developing in different trajectories.

Self-referral for these types of programs increases accessibility and acceptability to adolescents, thus leading to high engagement rates, even among minority groups. With follow-up rates of over 90%, these programs avoid stigmatization, unlike targeted interventions, while maximizing autonomy and efficiency.

The DISCOVER one-day workshop program uses self-referral, proven CBT methods, and more visual materials while allowing more clinician interaction. The CBT approach in this program involves methods to cope with mood fluctuations, anxiety, and stress. All workshops are provided by Mental Health Support Staff, who were first trained over two days.

About the study

The current study's design was a randomized controlled trial (RCT), with schools offering either the DISCOVER workshop or the usual treatment. Herein, researchers explored whether CBT through DISCOVER workshops could be an accessible, scalable, and evidence-based intervention.

All study findings were categorized by study site and matched by school size as well as deprivation indices.

What is a DISCOVER workshop?

Each workshop presented adolescent experiences, including role plays and group discussions. The problems that are often encountered in this age group include personal problems, relationship issues, and academic challenges. Workshop participants were coached using multiple media to use CBT for anxiety and mood problems.

During the workshops, participants were taught problem-solving skills and encouraged to build healthy sleep habits, use their time efficiently, and identify and correct unhealthy thoughts. The issues covered in the workshop were provided in digital format through a phone application for further reference.

After one week, follow-up sessions were held by telephone, during which researchers monitored the real-life use of the new skills. Two additional reviews were offered within the 12 weeks following the workshop.

What did the study show?

The DISCOVER group included 443 students from 26 schools, 67% of whom were female, whereas the usual treatment group comprised 457 students from 31 schools, 76% of whom were female. About 52% of the participants were White, with a mean age of 17.

At six months, depression symptoms measured with the Mood and Feelings Questionnaire (MFQ) were reduced by a mean of two points in the DISCOVER group. When only those with pre-existing depressive symptoms were included, a four-point improvement in symptoms was observed. Wellbeing, anxiety, and resilience all significantly improved in the DISCOVER group, in addition to good attendance and satisfaction.

The DISCOVER intervention costs about £110 per student, for a total cost of about £150 more than the control treatment. There was a 60-80% likelihood of DISCOVER being cost-effective compared to the control treatment, which cost £20,000-30,000 per quality-adjusted life-year (QALY) threshold.

Conclusions

The findings indicate modest clinical efficacy for the DISCOVER workshops while demonstrating their financial viability. The effectiveness of this intervention exceeded the clinically meaningful threshold for students who were already depressed at the baseline.

Compared with other studies based on a universal CBT approach or curriculum-based mindfulness training, the DISCOVER workshops appear to provide superior results. The use of the newly appointed Mental Health Support Staff, the deployment of CBT techniques, and the acceptability and accessibility of the intervention may have contributed to the success.

The high proportion of those who had not previously sought help through formal routes (80%) underscores the value of this approach with this group who are not keen to consult professionals.”

DISCOVER workshops could represent a promising school-based early intervention, especially if the program's effects persist into adulthood. Nevertheless, additional research is needed to validate and follow up on these findings, which is important given the increasing need for mental health care provisions in adolescents.

Notable limitations of the current study include the significantly smaller proportion of students who wanted to know about the workshop but did not eventually attend it and the relative lack of male attendees.