A Comparison of Acceptance and Commitment Therapy and Cognitive Behavioural Therapy for Enhancing Adolescent Mental Health Within School Curricula

<br> CBT is the gold standard for universal prevention of depression in school-based adolescents, however not all studies have shown CBT to be effective. In some studies participants at higher risk of depression and anxiety have benefitted the most, with no benefit for participants who were not at risk. Some studies have used small group sizes with psychologists as facilitators, which could be difficult for schools to replicate. Assessment of important factors such as participation rates, session attendance rates, attrition rates, consumer satisfaction, and intervention integrity and fidelity have not been conducted in all studies.<br><br> The research using ACT with adolescents for depression, anxiety, stress, risk taking behaviour and wellbeing shows promising results on the basis of a small number of studies. To date four have used ACT as part of a universal school-based intervention, of which two are unpublished, and one combined ACT with positive psychology.<br><br> The current study was a pilot equivalency trial that aimed to compare the effectiveness of ACT and CBT for preventing depression and stress and enhancing mental health. Given the empirical support for the effectiveness of ACT for the treatment of mental illness, the aim was for the ACT intervention to be equivalent to the CBT intervention. Participants were ninth grade students (N = 99) aged 14-16 years in two schools in Melbourne, Australia who were randomly allocated to either an ACT or CBT eight-week group intervention during regular class time as part of the school curriculum, using regular class sizes. Participants completed the Depression, Anxiety and Stress Scales (DASS), General Self-Efficacy Scale (GSES), Patterns of Adaptive Learning Scales (PALS), Acceptance and Action Questionnaire-II (AAQ-II), Kentucky Inventory of Mindfulness Skills (KIMS), and Children’s Coping Strategies Checklist-Revision 1 (CCSCR-1). The outcome measures were completed at baseline, post-intervention, and at six and 12-months after the end of the interventions. Putative mechanisms of change were measured by the AAQ-II and KIMS, which were administered midway through the interventions.<br><br> This study found that the time trajectories of the ACT and CBT interventions were not distinguishable, and that neither intervention was effective given a lack of improvement on the primary and secondary outcome variables. At baseline, the sample was very high in self-reported scores of self-efficacy and productive coping strategies, and very low in self-reported scores of depression, stress, anxiety, experiential avoidance, and unproductive coping strategies. As a result, a floor effect may have occurred, where no intervention effect was detected because the sample was well in terms of scores on measures of mental health at baseline and not endorsing any difficulties.<br><br> Moderation was examined and the interventions were found to be associated with distinct and contrasting moderators. Suggestions are provided about how to embed ACT concepts across school curricula and conduct whole-school approaches using ACT, and how to use technology to engage adolescents and reinforce the key concepts of the intervention