adolescents

The objective of this investigation was to assess the efficacy of an Acceptance and Commitment Therapy (ACT)-based group psycho-educational intervention within school environments, administered by psychologists, for early adolescents in Japan. The effectiveness indices measured in this study were ‘clarification of value and commitment (CVC)’ and ‘experiential avoidance (EA)’ as indicators of psychological flexibility of ACT, and self-esteem and self-determination disposition as outcome indices related to well-being. The participants in this study were Japanese junior high school students with a mean age of 14.85 years (SD = 0.86), 112 in the intervention group and 143 in the control group, who completed questionnaires at three time points: before the program (pre), after attending the program (post) and three weeks after the posttest (follow-up). The intervention program, which consisted of three short-term sessions, was shown to be effective in the CVC, self-esteem, and self-determination disposition scores. Conversely, the group-time interaction did not yield a notable impact on the persistence of avoidance behaviors and EA scores, suggesting a potential avenue for refinement in intervention methodologies regarding these domains. These findings offer insight into the potential effectiveness of ACT-based group psycho-educational endeavors in school settings led by psychologists.

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Third wave interventions have demonstrated efficacy as a treatment option to promote wellbeing in adolescents. Evidence of their effectiveness for chronic mental health disorders remains unclear. The PubMed, PsycINFO, ProQuest, Embase, and CINAHL databases were searched from inception until March 2024 for five established interventions: acceptance and commitment therapy (ACT), compassion focused therapy, dialectical behaviour therapy (DBT), mindfulness-based cognitive therapy, and mindfulness-based stress reduction (MBSR). Risk of bias was assessed (QualSyst tool), and standardized mean group differences (Hedges’ g) with associated p-values, 95% confidence intervals, and prediction intervals calculated. Three randomized controlled trials and 10 single-group designs, all assessing DBT and representing 700 adolescents (most with subthreshold or full syndrome borderline personality disorder), were included. All studies were of sound methodological quality. DBT was associated with large and significant reductions in mental health symptoms (depression, anxiety, emotional regulation, suicidal ideation, self-harm, and BPD symptoms; g range = 0.69 to 1.05) – although individual variability in treatment response was noted. Symptom improvements were maintained at follow-up (g range = 0.70 to 1.71), although based on limited data. Neither DBT intensity nor duration significantly moderated treatment effects. DBT is the most assessed intervention for adolescents with severe emotional or behavioral problems. Additional controlled studies with diverse samples are needed to confirm the unique effects of DBT relative to other promising third wave interventions. Protocol registration: Open Science Framework [https://osf.io/fgd2j/].

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Emotion dysregulation and psychological inflexibility are widely regarded as key contributors to a range of mental health issues and are integral to several treatment models in the mental health field. However, no study has examined whether the two constructs reflect distinct aspects of psychological functioning or whether they can be clearly differentiated from mental health symptoms and associated impairment. Adolescence is a key period for the onset of mental health problems, making a better understanding of psychological processes involved in mental health in this age group important. The Difficulties in Emotion Regulation Scale (DERS-16, emotion dysregulation) and the Avoidance and Fusion Questionnaire for Youth (AFQ-Y8, psychological inflexibility) are widely used assessment tools of emotion dysregulation and psychological inflexibility, but critical evaluations of their validity are sparse. Using exploratory and confirmatory factor analysis, we examined the discriminant validity of emotion dysregulation and psychological inflexibility as measured via the DERS-16 and the AFQ-Y8 in a sample of 633 adolescents (M_age = 16.6 [1.98]). Emotion dysregulation and psychological inflexibility did not demonstrate discriminant validity. Instead, four strongly correlated factors emerged, each comprising a combination of items from both assessment tools: (1) interference stemming from distressing thoughts and emotions, (2) negative self-evaluation, (3) loss of control when emotional, and (4) confusion about one's emotions. These factors were strongly correlated and adequately captured by an overarching factor, which we termed the X factor, which in turn was very strongly correlated with core symptoms of anxiety and depression and functional impairment stemming from mental health issues. In conclusion, the constructs of emotion dysregulation and psychological inflexibility, as assessed by the DERS-16 and AFQ-Y8, do not show discriminant validity in adolescents. Furthermore, the constructs measured by these tools are almost empirically indistinguishable from anxiety, depression, and functional impairment.

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To address limited access to behavioral health services in primary care, we conducted a preliminary effectiveness study of a novel acceptance and commitment therapy group treatment implemented within pediatric integrated primary care (ACT-IPC) using a retrospective cohort study design. Participants included 110 youth referred after psychological evaluation between 2015 and 2019. ACT-IPC was implemented in nine sessions; participants had a variety of primary psychiatric diagnoses and were predominantly White (93%) and female (81%) with an average age of 15.1 (SD = 1.5). Anxiety (d = −0.71) and depression (d = −0.54) symptoms improved significantly, as did psychological inflexibility (d = −0.52). Additionally, up to three individualized treatment goals were established and tracked weekly. These outcomes also improved significantly (d = −.69 to d = −1.42), and the first two goals evidenced the majority of improvement within approximately the first half of treatment. Reliable and clinically significant change was promising on all outcomes, and few iatrogenic effects were observed. Of note, concurrent individual therapy and psychotropic medication were prevalent within the sample and were not associated with improved outcomes. Overall, findings provide preliminary transdiagnostic effectiveness and feasibility of ACT-IPC and represent a positive example of a reticulated contextual behavioral science approach to treatment development.

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