Adolescence is often marked by significant mental stress, which heightens the risk of anxiety and depression. To combat this, schools across the United Kingdom have evaluated a stress workshop program aimed at young people aged 16 to 18.
This initiative was part of the Brief Educational Workshops in Secondary Schools Trial (BESST). The findings, published in The Lancet, reveal the clinical and cost-effectiveness of the workshop six months post-intervention compared to standard treatment.
Mental Health Care in Adolescence
More than 50% of adult mental health disorders begin before age 15, with 75% developing by age 18. In 2022, over 25% of individuals aged 17 to 19 were estimated to have a mental health disorder, up from 17% in 2021. Alarmingly, around 60% of children and adolescents with clinically diagnosable mental health issues in the U.K. do not receive specialized care through the Child and Adolescent Mental Health Services (CAMHS).
Specialist cognitive behavioral therapy (CBT) is shown to be particularly effective for older adolescents, whose brains are rapidly maturing, with changing sleep patterns and developing coping mechanisms. Self-referral programs increase accessibility and acceptability among adolescents, leading to high engagement rates even among minority groups. With follow-up rates exceeding 90%, these programs reduce stigmatization and maximize autonomy and efficiency.
The DISCOVER Workshop Program
The DISCOVER one-day workshop program employs self-referral, proven CBT methods, visual materials, and increased clinician interaction. This approach helps adolescents manage mood fluctuations, anxiety, and stress. Mental Health Support Staff, trained over two days, facilitate all workshops.
Study Overview
The study was a randomized controlled trial (RCT) where schools provided either the DISCOVER workshop or standard treatment. Researchers aimed to determine if the DISCOVER workshops could serve as an accessible, scalable, and evidence-based intervention. Study findings were categorized by site, school size, and deprivation indices.
What is a DISCOVER Workshop?
Workshops addressed common adolescent issues through role plays and group discussions, covering personal problems, relationship issues, and academic challenges. Participants learned CBT techniques for managing anxiety and mood problems, alongside problem-solving skills, healthy sleep habits, efficient time use, and recognizing unhealthy thoughts. Workshop content was available digitally via a phone application for further reference.
Follow-up sessions were conducted by phone one week after the workshop, with additional reviews within the subsequent 12 weeks to monitor skill application in real-life scenarios.
Study Results
The DISCOVER group included 443 students from 26 schools, 67% of whom were female. The usual treatment group had 457 students from 31 schools, 76% of whom were female. About 52% of participants were White, with an average age of 17.
At six months, depression symptoms measured by the Mood and Feelings Questionnaire (MFQ) decreased by an average of two points in the DISCOVER group. Among those with pre-existing depressive symptoms, a four-point improvement was noted. Well-being, anxiety, and resilience significantly improved in the DISCOVER group, along with good attendance and satisfaction.
The DISCOVER intervention cost approximately £110 per student, with a total cost about £150 higher than the control treatment. There was a 60-80% likelihood of DISCOVER being cost-effective, with a cost of £20,000-30,000 per quality-adjusted life-year (QALY) threshold.
Conclusions
The findings suggest modest clinical efficacy for DISCOVER workshops, while also demonstrating financial viability. The intervention’s effectiveness surpassed the clinically meaningful threshold for students with baseline depression.
Compared to other universal CBT or mindfulness-based interventions, DISCOVER workshops yielded superior results. The success of this program may be attributed to the newly appointed Mental Health Support Staff, the implementation of CBT techniques, and the program’s acceptability and accessibility.
