Mindfulness-based Therapy for Adolescent Mental Health Problems

High school is a period of great social and academic pressure for students. This pressure can lead to many serious consequences like mental health problems. As a health professional, discuss some intervention strategies that would be beneficial in reducing systems of mental illness in adolescents.

Mental health is described as the state of psychological wellbeing where the individual is able to cope with everyday tasks, fulfil their potential and contribute to society (Kumari, 2012). A individual with a mental illness experiences significant distress and impairment of function. Approximately a fifth of the global population has a mental illness, and because of global economic burdens it contributes, the World Health Organisation (WHO) deems public health intervention should be prioritised. Annually, premature death of people suffering from mental illnesses amounts to fifteen billion dollars. The psychological phenomenon, pressure, is often used interchangeably with stress. However, it is not well distinguished from ‘stress’, which is generally agreed that it is the state of physiological and psychological arousal that is perceived by the individual as exceeding abilities or resources to cope. Pressure is associated with the expectations to produce desirable outcomes (Weisinger & Pawliw-Fry, 2015). Adolescents spend around 1/3 of a day at school, and this is arguably one of the most important and fragile social context in their lives. Formation of values occurs here, giving meaning and fortifying their sense of self (Kumari, 2012).

The primary social influences during adolescence are peers and family. Conflicts between the adolescents and parents can deteriorate relationships, can prompt attempts at suicide (Goldstein, Davis-Kean, & Eccles, 2005). It is worthy to note that students without college-educated parents are more likely to endure more life-stressors and are impacted to a greater degree than students with college-educated parents. Family stressors, that were out of their own control, were found to be harmful towards academic achievement (Morazes, 2016). In addition, parents that don’t exercise discipline and are lax in their parenting, this may result in their children making ill-informed choices with their peers. Of the perspective of the child, if they perceive to lack autonomy, the parent-relationship will be weakened, making the child vulnerable to mental disorder (Goldstein et al., 2005). Difficulties with peers in school, peer pressure to engage is risky behaviour and bullying play a significant role in the decline of mental health (Karakos, 2014).

(Morazes, 2016 #18)

Yusoff et al. (2011) defined academic pressure as an outcome of disproportionate workloads and inappropriate treatment of teachers. On a similar strand, Silvar (2001) proposed that high expectations from teachers and family members, inadequate support from interpersonal relationships, little or none perceived control, and lack of acknowledgement or reward for high achievement contributes to academic stress. Academic performance is highly regarded by society. This is unhelpful to those identified as less capable are disadvantaged mental health-wise and career-wise, as low achievement poses a risk factor for the development of depression. Furthermore, depression impairs a young person’s ability to cope with academic demands. Females experience more severe depressive symptoms when it comes examination related demands (Fröjd et al., 2008). High achieving students are more prone to internalised disorders (e.g., depression) and lower life satisfaction when they utilise anger coping skills to deal with rising levels of stress due to demanding academic standards. (Suldo Shannon, Shaunessy, & Hardesty, 2008) Academic pressures can contribute to burnout, which then the student suffers consequences to their mental health, which predisposes them to a higher risk of depression and lower self-esteem (Silvar, 2001). Detailed in the following paragraphs will be among the most scientific rigorous interventions aimed at improving mental health among adolescents.

Mindfulness-based therapy is an emerging intervention in psychotherapy for a broad array of physical conditions (e.g. cancer) and psychological conditions (e.g. depression) that seems to be garnering favourable attention (Hofmann, Sawyer, Witt, & Oh, 2010). A person is in mindfulness state when they exercise nonjudgmental awareness of internal and external stimuli, whilst promoting acceptance and curiosity of our thoughts, feelings and behaviour. This reduces the effects of stressors as attending to the present experience, because by doing so, the person avoids orienteering towards anxious and depressive stressors associated with the past and future. Thus, prevents the occurrence of anxiety responses which prevents altogether the stimulation of maladaptive neuronal circuits that triggers the anxiety response. Mindfulness encourage reflective reactions, allowing the brain to counter fear-based avoidance strategies (Bostic et al., 2015). There is sufficient evidence to state mindfulness’ effectiveness. One study highlights the physical changes in the brain of a person with bipolar disorder or depression when they undergo an 8 month treatment. High activity was observed in the left prefrontal lobe; this is consistent with monks who meditate. Left prefrontal cortex activity is associated with feeling elevated (Davidson & Begley, 2012). Furthermore, consistent mindfulness practice will dramatically reduce stress hormone levels (Aguirre & Galen, 2013). Implementing mindfulness in schools has been more common recently, as valid research alludes to the practice’s significant influence on cognitive performance, stress and resilience (Durlak, Weissberg, & Dymnicki et al., 2011). Moreover, it is shown that schools were advantaged academically from mindfulness interventions (Durlak, Weissberg, & Dymnicki et al., 2011). Findings from a meta-analyssis by Hofmann et al. (2010) determined that among those who with high anxiety levels, mindfulness was moderately strong at reducing stress. As well as the non-clincal population, mindfulness had efficacy in reduction of stress in people with mood and anxiety disorders (Hofmann et al., 2010). This suggests that mindfulness targets underlying processes that regulate well-being in all individuals and is not diagnostic-specific. The study is limited by most of the studies’ qualitative natures, and thus do not quantify the size of treatment effect. Addition to this, sample sizes of trials of quantitative nature were small. Effect size of less than half of the studies were calculated, but nevertheless still significant. Also, the study was limited by the meta-analytic method (Hofmann et al., 2010).

Mental health literacy plays a significant role in promoting mental health, discouraging stigma, ensuring students will be informed in making decisions related to their mental health by enhancing understanding of mental illnesses and treatments, and improving help-seeking efficacy (Kutcher, Bagnell, & Wei, 2015). The WHO has identified the need to elevate the importance of health literacy to improve health outcomes globally. Currently, it is believed that adolescents should be the main audience of mental health literacy as health-related decision making commences then, hence the importance of equipping students with resources to aid this. Also, the onset of mental illnesses starts between 12 to 25, so promotion of mental health literacy during that age group is appropriate and ideal to boost mental health outcomes (Kutcher et al., 2015). Interventions are provided either through curriculum, through school-based initiatives (e.g. R U OK Day), connecting schools to off-site services or connecting with health care providers. These approaches involve bringing external resources to school sites, which may not be economically viable to sustain long term (Kutcher et al., 2015). It may be more ineffective than a school’s teacher addressing the class themselves (Weare & Nind, 2011). Guest speakers that were invited to schools were often noneducators, and were one-off interventions. There is little scientific backing of the intervention successfully meeting of all 4 outcomes (understanding mental health and how to maintain it, understanding mental disorders and treatments, improve help-seeking efficacy and reducing stigma) (Kutcher et al., 2015). Reduction of stigma did not benefited from non-sustained efforts. The shift from textbooks and class handouts to interactive mediums signals towards the need to keep updated with ever-changing learning needs. An effective approach trialed in Canada to counter aforementioned barriers involves school teachers attending a one-day development program, and are taught how to use a web-based curriculum resources. Prior to the training, teachers did not feel comfortable or knowledgeable enough addressing materials in the curriculum (Kutcher et al., 2015). Both students and teachers benefited from this intervention, and it is the most effective intervention documented consistently in other studies (Weist et al., 2017).

A common intervention is cognitive behaviour therapy (CBT)-based aimed at highlighting the value of resilience to reduce likelihood of developing a mental disorder. Resiliency to the ability to cope and adapt to adversity and stress. Resilience is relative and not fixed, and is dynamic in the way it acts on risk and protective factors to reduce the effects of adversity (Olsonn et al., 2003). Resilience also brings about positive change in the individual, such as expanded insight about the self, growth, protecting us from psychological and physiological harm during critical times (Richardson, 2002). Resilience and other positive characteristics can be taught in schools (Green et. al, 2011). CBT addresses modifies irrational and dysfunctional thoughts, by identifying person strengths, developing strategies to harness strengths, applying and practicing strategies (Padesky & Mooney, 2012). The person is likely to become more resilient as more experiences are endured. CBT has shown beneficial effects in depressive and anxiety-related symptoms, but there is insufficient evidence to support CBT’s effect on suicidal tendencies (Kavanagh et al., 2009). Studies shows that among 20-30% of mood disorders are treatable using CBT (Prevention of depression and anxiety in Australian schools, 2018). CBT aimed at improving resiliency outcomes for youths were commonly delivered in groups in 4-18 sessions (Reaveley et al., 2015). A meta analysis conducted by Reaveley et al. (2015) concluded that CBT was mostly moderately effective against PTSD, depression, eating disorders and improving resiliency. However, anxiety disorders benefited greatly from CBT. Reviews of other studies have found CBT also targeted antisocial behaviour, aggression and violence (Weare & Nind, 2011) Further studies on art-based therapies that were based on CBT components saw a significant impact on anxiety, with ¾ of participants reported a markedly reduced levels of anxiety (Regehr et al., 2013). In particular, CBT-based interventions aimed at reducing anxiety-related symptoms have been transferred to other countries, and has found success (Shucksmith et al., 2007). However, the CBT resilience interventions tended to emphasise symptoms of the disorder rather than the strengths (Reaveley et al., 2015). To maximise CBT’s potential, the adolescent must be engaged and committed towards the process (Kavanagh et al., 2009). More research on strengths-based interventions is needed, as previous research has been inconsistent, to determine its true potency against non strength-based interventions.

Secondary schooling has always been a source of stress for many adolescents. Students are pushed to be performing academically at the top by parents, teachers and themselves, at the expense of their own mental health (Walburg, 2014). How adolescents relate to parents and their peers may also have significant impacts. Outlined in this essay are strategies to improve mental health outcomes, and are all underpinned by the purpose of enhancing levels of mental health in young people and reduce mortality of people with mental disorders. This in turns addresses the long waitlist and transportation requirements in the clinical health care systems. Stressors derived from social and academic backgrounds can manifest themselves as clear risk factors for developing mental health issues, hence the mental health promotion should be continued, explored and advocated to enable students to thrive in adversity.

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