May 14, 2024

expert reaction to an RCT of a school based CBT programme for stress in adolescents

A study published in Lancet Psychiatry looks at school based CBT programmes for school-aged adolescents. 

Prof Stella Chan, Charlie Waller Chair in Evidence-based Psychological Treatment, University of Reading, said:

“This is a very important clinical trial addressing one of the most urgent mental health challenges. The study design and execution are scientifically robust, yielding to reliable data that has a clear implication to real life practice. The key findings are encouraging in that a one-day workshop delivered in community setting can reduce symptoms of depression and anxiety in 16–18-year-old adolescents, with the added advantage of providing young people a self-referral route to support. It should however be highlighted that while the reduction in symptoms was statistically significant, meaning that the change was above and beyond a chance level, the effect sizes were only modest. It is therefore crucial for further research to find out how long the beneficial effects last, and what booster sessions or other support would help sustain mental health. It is also important to understand that this study sample was predominately female, limited to 16-18 years old, and adolescents needed to self-refer to receive the intervention. Future research would be crucial in examining whether and how the intervention could benefit other gender groups, a wider age group, and those with less ability or confidence to self-refer.”

Prof David Curtis, Honorary Professor, UCL Genetics Institute, UCL, said:

“This study reports that school students reporting mild mental health problems at a particular point in time tend to be improved a few months later, and that this improvement is slightly greater in those who have enrolled in a one-day workshop based on CBT principles. The main concern is the lack of blinding of the study, meaning that the students know perfectly well whether or not they have participated in the treatment program. This means that those who have spent a day engaging in this workshop may tend to subsequently report slightly better mental health but we do not know whether this may be due to some conscious or unconscious bias rather than resulting from any real therapeutic effect.

“It is a serious and not uncommon problem that trials of psychological treatments fail to incorporate a plausible placebo intervention or active control treatment. Since this results in the participants not being blind to whether or not they are being treated this inevitably undermines the ability to draw any conclusion as to whether or not the treatment is in fact effective. Researchers and funding bodies should recognise that, while including a placebo treatment can make a trial more expensive, failing to do so can render a trial close to valueless.”

Prof Bernadka Dubicka, from the University of York and Hull York Medical School, said:

“This is a large, well run trial for young people experiencing stress, using existing mental health support within schools to deliver a workshop with some individual sessions. However, although well attended, the effects of the intervention were small in the short-term, and, as the population was self-selecting, it is not clear how certain groups may have benefited from the program, such as boys who were much less likely to be involved. 

“The main question which needs to be answered is whether this is the best use of the very limited mental health support resource within schools, or whether these mental health teams are more effectively used to target those young people who are referred for identified mental health problems. 

“The roll out of mental health support teams in schools and colleges needs to be urgently accelerated to meet the existing needs of young people in crisis; follow up data from this study will tell us if this intervention may also be worthwhile in the longer term for some young people.”

‘Clinical effectiveness and cost-effectiveness of a brief accessible cognitive behavioural therapy programme for stress in school-aged adolescents (BESST): a cluster randomised controlled trial in the UK’ by June Brown et al. was published in The Lancet Psychiatry at 23:30 UK time on Tuesday 14^th May.

DOI: 10.1016/S2215-0366(24)00101-9

Declared interests

Prof Stella Chan: No COI

Prof Dave Curtis: I have no conflict of interest to declare.

Prof Bernadka Dubicka: “I am funded by the NIHR – Chief Investigator of the BAY trial, which is testing a brief intervention for depression in CAMHS.”

This Roundup was accompanied by an SMC Briefing.