Effectiveness of the Super Skills for Life programme in enhancing the emotional wellbeing of children and adolescents in residential care institutions in a low- and middle-income country: A randomised waitlist-controlled trial

Integrating "Super Skills for Exams" Programme in the School Curriculum to Support Adolescents Preparing for Their National Examinations in Turkey

Examination stress is the most common stressor reported by adolescents across the globe. Exam stress involves mental distress related to anticipated academic challenges or fear of failure in the examinations, test anxiety, or fear of being unable to meet certain expectations of themselves or others. The aim of this study was to determine the effectiveness of a transdiagnostic resilience program (Super Skills for Exams; SSE), when integrated in the school curriculum and delivered by the school counsellors, in reducing exam stress among adolescents who are preparing for their national examinations. SSE is based on the principles of Cognitive Behaviour Therapy (CBT), behavioural activation, and social skills training, and includes sessions in promoting healthy lifestyles. Participants were 7129 (3661 female and 3468 male) adolescents in grades 7 and 8, from all the 245 secondary schools from Ugur College in seven regions and 31 cities across Turkey. All the participants completed a set of questionnaires to measure self-efficacy for learning and test anxiety, academic stress, emotion regulation, and lifestyles. Results revealed significant reduction in academic stress (i.e., test anxiety, work pressure, self-expectation, and despondency) and maladaptive emotion regulation strategies, and significant increase in self-efficacy and adaptive regulation strategies following the intervention. Adolescents who participated in SSE reported an increase in the consumption of healthy food. This study provides preliminary empirical support for the integration of SSE within the school curriculum for helping adolescents cope with exam stress as they prepare for their national exams.

Research Review: Psychological and psychosocial interventions for children and adolescents with depression, anxiety, and post-traumatic stress disorder in low- and middle-income countries - a systematic review and meta-analysis

BACKGROUND

The incidence of depression, anxiety, and post-traumatic stress disorder (PTSD) among children and adolescents residing in low- and middle-income countries (LMICs) poses a significant public health concern. However, there is variation in the evidence of effective psychological interventions. This meta-analysis aims to provide a complete overview of the current body of evidence in this rapidly evolving field.

METHODS

We conducted searches on PubMed, Embase.com, and EBSCO/APA PsycInfo databases up to June 23, 2022, identify randomized controlled trials (RCTs) investigating the effectiveness of psychological interventions in LMICs that targeted children and adolescents with elevated symptoms above a cut-off score for depression, anxiety, and PTSD, comparing a psychological or psychosocial intervention with other control conditions. We conducted random effects meta-analyses for depression, anxiety, and PTSD symptoms. Sensitivity analysis for outliers and high-risk studies, and analyses for the publication bias were carried out. Subgroup analyses investigated how the intervention type, intervention format, the facilitator, study design, and age group of the participant predicted effect sizes.

RESULTS

Thirty-one RCTs (6,123 participants) were included. We found a moderate effect of interventions on depression outcomes compared to the control conditions (g = 0.53; 95% CI: 0.06-0.99; NNT = 6.09) with a broad prediction interval (PI) (-1.8 to 2.86). We found a moderate to large effect for interventions on anxiety outcomes (g = 0.88; 95% CI: -0.03 to 1.79; NNT = 3.32) with a broad PI (-3.14 to 4.9). Additionally, a moderate effect was observed on PTSD outcomes (g = 0.54; 95% CI: 0.19-0.9; NNT = 5.86) with a broad PI (-0.64 to 1.72).

CONCLUSIONS

Psychological and psychosocial interventions aimed at addressing depression, anxiety, and PTSD among children and adolescents in LMICs have demonstrated promising results. However, future studies should consider the variation in evidence and incorporate long-term outcomes to better understand the effectiveness of these interventions.

Cross-culturally adapted psychological interventions for the treatment of depression and/or anxiety among young people: A scoping review

BACKGROUND

Mental health problems among young people are a major global public health challenge. Psychological interventions may improve mental health, yet most are developed in western cultures, and it is unclear whether they are applicable to other geographical settings and can be delivered successfully to diverse populations. We identified empirical studies focusing upon cross-culturally adapted psychological interventions and examined the cultural adaptation process used and the effectiveness of the interventions in the treatment of depression and/or anxiety disorders among young people (defined here as children and adolescents aged between 8-18 years).

METHOD

We conducted a scoping review aligning to the guidelines reported in the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for Scoping Reviews (PRISMA-ScR) Statement. Stakeholder engagement enabled us to discuss the findings of the review and obtain feedback.

RESULTS

We identified 17 studies of cross-culturally adapted psychological interventions that considered the appropriate language, metaphors, culturally appropriate terms, and cultural values of young people. Most studies (n = 11) adopted a randomised control trial (RCT) methodology. Six studies used the ecological validity and cultural sensitivity framework. Planned adaptation, cultural adaptation of content, and surface and deep structure level adaptations were used in other studies. Apart from one pilot study, all studies reported that culturally adapted interventions resulted in improvements in depression and/or anxiety symptoms in young people. The results suggest the potential effectiveness of cross-culturally adapted interventions within this context. Our stakeholder consultations demonstrated that engaging different community-level stakeholders in the adaptation process was highly recommended.

CONCLUSIONS

Whilst most included studies indicated improvements in depression and/or anxiety symptoms in young people following a cross-culturally adapted intervention, more work is needed in this area. In particular, focus should be placed upon identifying the dimensions of interventions that should be culturally adapted to make them acceptable, engaging and effective.

Benefits of Super Skills for Life in a randomized controlled trial in clinical settings for Spanish children with comorbid conditions

Emotional disorders in children are often associated with low self-concept and problems with peers, and in many cases externalizing symptoms. Super Skills for Life (SSL) is a transdiagnostic treatment for emotional problems in children that has also shown benefits in other comorbid symptoms. This study aimed to examine, for the first time, the effect of SSL on a clinical sample of Spanish children aged 8-12 years with a major emotional disorder and comorbid externalizing symptoms and low self-concept. A quasi-experimental design with two groups, pretest and posttest, was carried out. Thirty-eight children received the SSL intervention, and 36 children were assigned to a wait-list control (WLC) group. Children in SSL showed statistically fewer posttest emotional symptoms (p < .001), peer problems (p = .002), and overall internalizing and externalizing difficulties (p = .005) compared to children in WLC, in addition to higher posttest self-concept (p = .002). There were no differences in the postinterventional changes between boys and girls in internalizing and externalizing symptoms. However, significant differences were found in some facets of self-concept. The results of this study suggest that the SSL protocol may be useful in Spanish clinical contexts. Still, more research is needed to overcome some of the inherent limitations.

The Role of Emotion Regulation and Executive Functioning in the Intervention Outcome of Children with Emotional and Behavioural Problems

Emotional and behavioural problems are closely associated with impairments in regulating emotions and in executive functions (EF). To examine this further, the aim of the present study was to determine whether EF and emotion regulation at baseline would predict emotional and behavioural problem scores post-intervention, and further explore the extent to which emotion regulation mediates these outcomes. Participants were 41 primary school children who exhibited emotional and/or behavioural problems, aged 8 to 11 years. All the children completed measures of emotional and behavioural problems, cognitive emotion regulation, anxiety symptoms, and performed two experimental tasks to measure working memory and response inhibition before and after participating in a transdiagnostic Cognitive Behaviour Therapy-based programme, "Super Skills for Life" (SSL), and at 3-months follow-up. Results revealed significant reduction in the use of maladaptive emotion regulation strategy catastrophising and other blame following the intervention. Additionally, EF and emotion regulation was associated with outcomes for emotional problems and conduct problems. More specifically maladaptive emotion regulation strategy such as catastrophising and other blame was closely related with self-reports of emotional problems, likewise other blame, was also linked with scores of conduct problems. This study provides preliminary empirical support for EF and emotion regulation in predicting outcomes of emotional and behavioural problems in children following intervention.

Adaptation and validation of two annotation scales for assessing social skills in a corpus of multimodal collaborative interactions

Context

Behavioral observation scales are important for understanding and assessing social skills. In the context of collaborative problem-solving (CPS) skills, considered essential in the 21st century, there are no validated scales in French that can be adapted to different CPS tasks. The aim of this study is to adapt and validate, by annotating a new video corpus of dyadic interactions that we have collected, two observational scales allowing us to qualitatively assess CPS skills: the Social Performance Rating Scale (SPRS) and the Social Skills of Collaboration Scale (SSC).

Method

The construct validity of these two scales was assessed by exploratory factor analysis and inter-item correlations. We also checked inter-judge agreement using inter-class correlation coefficients. Internal consistency was determined using Cronbach's alpha and convergent and divergent validity by assessing correlations between the two scales and measures of depression and alexithymia. Finally, the discriminative properties of the two scales were analyzed by comparing the scores obtained by a group of anxious individuals and a non-anxious control group.

Results

The results show that our two scales have excellent inter-item correlations. Internal consistency is excellent (alpha SPRS =0.90; SSC = 0.93). Inter-rater agreement ranged from moderate to high. Finally, convergent validity was significant with the alexithymia scale, as was divergent validity with the depression scale. Anxious individuals had lower scores on both scales than non-anxious individuals.

Conclusion

Both scales show good psychometric properties for assessing social skills relevant to different collaborative tasks. They also identify individuals with difficulties in social interaction. Thus, they could allow monitoring the effectiveness of training social skills useful in CPS.

The Effectiveness of the Super Skills for Life (SSL) Programme in Promoting Mental Wellbeing among Institutionalised Adolescents in Malaysia: An Interventional Study

Background: Mental health issues have become more prevalent among institutionalised adolescents. Therefore an effective intervention programme is needed to improve their mental health. Objective: To evaluate the effectiveness of the Super Skills for Life (SSL) programme in improving the mental wellbeing of institutionalised adolescents and determine the factors associated with their mental wellbeing. Methods: A quasi-experimental study involving 80 female institutionalised adolescents divided into intervention and control groups was conducted. Intervention involved implementation of the SSL programme. The effectiveness of the programme was evaluated based on several outcome parameters. Results: Factors including age, number of family members, perceived social support and self-esteem had significant correlations with mental wellbeing of participants. The SSL programme significantly improved the anxiety and stress levels of participants. Conclusion: SSL programme exclusively improves the mental wellbeing in institutionalised adolescents.

Prevention of Depression and Anxiety in Subclinical Adolescents: Effects of a Transdiagnostic Internet-Delivered CBT Program

Anxiety and depressive symptoms are common problems in adolescence that could be addressed by means of preventive interventions. Even though transdiagnostic cognitive behavior therapy (T-CBT) is potentially an ideal strategy to deal with anxiety and depression, it has rarely been used for preventive purposes. In addition, so far, no study has used internet-delivered T-CBT to prevent anxiety and depression in adolescents. This study aimed to examine the utility of AMTE, an internet-delivered T-CBT program, for the indicated prevention of anxiety and depression in adolescents. AMTE was applied to 30 adolescents (56.7% females, age range = 12–18 years, M_age = 14.00, SD_age = 1.89) who showed subclinical symptoms of anxiety and/or depression. Participants were assessed at pre- and post-treatment and follow-up (3 months). We found that after the program, the symptoms of self-reported anxiety and depression, clinician-rated symptom severity, and self-reported and parent-reported severity of the main problems had significantly improved. In addition, there were significant improvements in anxiety sensitivity and emotional avoidance. Finally, we found high feasibility and acceptability of the program. AMTE is feasible and potentially effective for the indicated prevention of anxiety and depression as well as of clinical transdiagnostic factors, in adolescents.

Pilot Study on the Effects of the Teaching Interpersonal Skills Program for Teens Program (PEHIA)

Background/Objective

Social skills are essential in adolescence, both for their relational dimension and for their influence on other areas of adolescent life, so it is essential to include Social skills in the formal education of students.

Method

This paper presents the results of an experimental mixed factorial design pilot study in which an Interpersonal Skills Training Program for Adolescents (PEHIA¹) was applied. The convenience sample consisted of 51 adolescents. An evaluation was carried out before and after the intervention, using the CEDIA (Adolescent Interpersonal Difficulties Assessment Questionnaire) and SAS-A (Social Anxiety Scale for Adolescents) questionnaires.

Results

The mixed factorial ANOVA show significant differences in the overall measures and in most of the subscales of both questionnaires, indicating that PEHIA is effectiveness, at least in the short term.

Conclusions

The results obtained in assertiveness, interpersonal relationships and public speaking suggest that the program is feasible and shows promising results in reducing anxiety. However, a larger scale study should be conducted.

Exploring the impact of a transdiagnostic cognitive behavioural therapy-based intervention on a group of Malaysian adolescents with problematic drug use and emotional problems

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After participating in the intervention, symptoms of emotional problems were significantly reduced.

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There was a significant reduction in substance use and maladaptive emotion regulation strategies after the intervention.

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Girls benefitted significantly more from the intervention compared to boys.

Introduction

Adolescents with problematic substance use frequently have anxiety and depression and tend to have “unhealthy” lifestyle such as having poor dietary patterns and physical inactivity. The overall aim of the present study was to explore the impact of a Transdiagnostic Cognitive Behavioral Therapy-based Intervention (“Super Skills for Life” – adolescent version; SSL-A) on emotional problems among adolescents with problematic substance use and to identify demographic factors which influence the intervention outcomes.

Method

A total of 108 adolescents (M = 16.30 years, SD = 1.6) with problematic substance use who showed high levels of anxiety and depression participated in this study. They completed a set of questionnaires to measure substance use, mental health problems, cognitive emotion regulation strategies, loneliness, and lifestyle and habits at pre- and post-intervention.

Results

The adolescents reported less emotional symptoms and more prosocial behavior after the intervention. These adolescents were also consumed less substance and used less maladaptive emotion regulation strategies after participating in SSL-A. Females compared to males showed more treatment gains (i.e., reduction in loneliness and improvement in psychological health and self-esteem) after the intervention.

Conclusion

This study provides empirical evidence for the utility of the SSL-A in reducing emotional problems and substance use among adolescents with problematic substance use.

A Meta-Analytic Review of Emotion Regulation Focused Psychosocial Interventions for Adolescents

Emotion regulation (ER) is the ability to monitor, evaluate, and modify one's emotional responses to be appropriate for environmental demands. Poor ER has been considered a transdiagnostic risk factor for a range of internalizing and externalizing disorders and overall decreased well-being in adolescents. A range of evidence-based interventions exist which may improve ER. However, much of the intervention research to date does not include a measure of ER to assess change pre and post treatment, with limited information about the efficacy of these interventions in youth across a range of sample types. There is a clear need for a comprehensive review of the literature examining ER-focused interventions in adolescents with a wide range of presenting disorders. A literature search was originally conducted in January 2020 and an updated search was conducted in February 2021 which elicited 1245 articles, of which 605 were duplicates and were removed. Abstracts of the remaining 640 articles were screened with 121 articles being reviewed in full. Of note, 16 additional articles were identified through references and other sources during this process and were also included in the full review. Of the 137 articles reviewed in full, 41 studies were ultimately included in the present review. The present paper provides a descriptive review of intervention approaches and findings from community prevention programs, programs for war-affected youth, programs for clinical populations, and programs for incarcerated and delinquent adolescents. The overall pooled effect was significantly different from zero based on the pre/post effects [Hedge's g = 0.29, 95% CI (0.22, 0.36)] and the intervention/control effects [Hedge's g = 0.19, 95% CI (0.06-0.32)]. Although neither sex nor age significantly accounted for heterogeneity in effect sizes, there were significant findings for population type (clinical vs. community), with community samples having significantly lower effect sizes on average. Impacts of the different ER measures used and significant methodological variability (e.g., use of control groups, length of intervention) across included studies are discussed. Implications and suggestions for future research are reviewed, specifically, that additional understanding of moderators of effects are needed and that measures used to assess change in ER, both dysregulation and adaptive skill use, may need to more directly align with the intervention's focus and the strategies taught as part of the intervention.