Want to improve school mental health interventions? Ask young people what they actually think

As part of the recent ‘therapeutic turn’ in education, schools are now commonly seen as a place for mental health guidance and support. This often involves interventions—special curricula of lessons or activities (e.g. counselling sessions), which aim to either prevent mental health problems or manage those that have already started. Running these interventions in schools makes good sense: rates of mental health problems in young people are rising, and large numbers can be reached in this setting. However, evidence for the effectiveness of such interventions has been mixed. One way to improve how helpful and useful they are, we argue here, would be to ask young people themselves what they think about these programmes. This involves collecting qualitative data: gathering in-depth information about young people's experiences and opinions, rather than relying solely on numerical data, such as rating scales. The small number of existing published qualitative studies in this area show that many young people do find these interventions helpful, but there are issues that warrant careful attention. For example, some young people can feel worried or vulnerable during classroom-based exercises, and others don't see how the interventions are relevant for their own lives. Here, we explore this literature and recommend two avenues for future work: ask more young people what they think of existing interventions, and get them involved in the design of new ones. Together, this will put young people's voices at the heart of school-based mental health interventions

Associations between age, social reward processing and social anxiety symptoms

Reward processing undergoes marked changes in adolescence, with social interactions representing a powerful source of reward. Reward processing is also an important factor in the development of social anxiety disorder, a condition that most commonly first appears in adolescence. This study investigated the relationship between age, social reward processing and social anxiety in a cross-sectional sample of female participants (N = 80) aged 13–34. Participants performed two versions of a probabilistic reward anticipation task, in which a speeded response could result in different probabilities of receiving either social or monetary rewarding feedback. Participants also completed self-report assessments of social reward value, trait anxiety and social anxiety symptoms. At high reward probabilities, performance on both reward tasks showed a quadratic effect of age, with the fastest responses at around 22–24 years. A similar quadratic effect was found for subjective liking ratings of both reward stimuli, although these were not associated with performance. Social anxiety was not associated with a subjective liking of the rewards but did predict performance on both tasks at all reward probabilities. Age-related variation in reward processing was not accounted for by age-related variation in social anxiety symptoms, suggesting that, while both social anxiety and age were associated with variation in reward processing, their effects were largely independent. Together, these findings provide evidence that social reward processing continues to develop across adolescence and that individual differences in social anxiety should be considered when considering reward sensitivity during this period

Associations between age, social reward processing and social anxiety symptoms

Reward processing undergoes marked changes in adolescence, with social interactions representing a powerful source of reward. Reward processing is also an important factor in the development of social anxiety disorder, a condition that most commonly first appears in adolescence. This study investigated the relationship between age, social reward processing and social anxiety in a cross-sectional sample of female participants (N = 80) aged 13–34. Participants performed two versions of a probabilistic reward anticipation task, in which a speeded response could result in different probabilities of receiving either social or monetary rewarding feedback. Participants also completed self-report assessments of social reward value, trait anxiety and social anxiety symptoms. At high reward probabilities, performance on both reward tasks showed a quadratic effect of age, with the fastest responses at around 22–24 years. A similar quadratic effect was found for subjective liking ratings of both reward stimuli, although these were not associated with performance. Social anxiety was not associated with a subjective liking of the rewards but did predict performance on both tasks at all reward probabilities. Age-related variation in reward processing was not accounted for by age-related variation in social anxiety symptoms, suggesting that, while both social anxiety and age were associated with variation in reward processing, their effects were largely independent. Together, these findings provide evidence that social reward processing continues to develop across adolescence and that individual differences in social anxiety should be considered when considering reward sensitivity during this period

Do no harm: can school mental health interventions cause iatrogenic harm?

In recent years, there have been extensive efforts in secondary schools to prevent, treat and raise awareness of adolescent mental health problems. For some adolescents, these efforts are essential and will lead to a reduction in clinical symptoms. However, it is also vital to assess whether, for others, the current approach might be causing iatrogenic harm. A growing body of quantitative research indicates that some aspects of school-based mental health interventions increase distress or clinical symptoms, relative to control activities, and qualitative work indicates that this may be partly due to the interventions themselves

Social Reward Questionnaire – Adolescent Version and its association with callous-unemotional traits

This article describes a study in which the adult Social Reward Questionnaire is adapted for use with adolescents

Age differences in the prosocial influence effect

Social influence occurs when an individual's thoughts or behaviours are affected by other people. There are significant age effects on susceptibility to social influence, typically a decline from childhood to adulthood. Most research has focused on negative aspects of social influence, such as peer influence on risky behaviour, particularly in adolescence. The current study investigated the impact of social influence on the reporting of prosocial behaviour (any act intended to help another person). In this study, 755 participants aged 8–59 completed a computerized task in which they rated how likely they would be to engage in a prosocial behaviour. Afterwards, they were told the average rating (in fact fictitious) that other participants had given to the same question, and then were asked to rate the same behaviour again. We found that participants' age affected the extent to which they were influenced by other people: children (8–11 years), young adolescents (12–14 years) and mid-adolescents (15–18 years) all significantly changed their ratings, while young adults (19–25 years) and adults (26–59 years) did not. Across the three youngest age groups, children showed the most susceptibility to prosocial influence, changing their reporting of prosocial behaviour the most. The study provides evidence that younger people's increased susceptibility to social influence can have positive outcomes

Amplified Concern for Social Risk in Adolescence: Development and Validation of a New Measure.

In adolescence, there is a heightened propensity to take health risks such as smoking, drinking or driving too fast. Another facet of risk taking, social risk, has largely been neglected. A social risk can be defined as any decision or action that could lead to an individual being excluded by their peers, such as appearing different to one's friends. In the current study, we developed and validated a measure of concern for health and social risk for use in individuals of 11 years and over (N = 1399). Concerns for both health and social risk declined with age, challenging the commonly held stereotype that adolescents are less worried about engaging in risk behaviours, compared with adults. The rate of decline was steeper for social versus health risk behaviours, suggesting that adolescence is a period of heightened concern for social risk. We validated our measure against measures of rejection sensitivity, depression and risk-taking behaviour. Greater concern for social risk was associated with increased sensitivity to rejection and greater depressed mood, and this association was stronger for adolescents compared with adults. We conclude that social risks should be incorporated into future models of risk-taking behaviour, especially when they are pitted against health risks

Research Review: The effects of mindfulness-based interventions on cognition and mental health in children and adolescents - a meta-analysis of randomized controlled trials.

BACKGROUND: Mindfulness based interventions (MBIs) are an increasingly popular way of attempting to improve the behavioural, cognitive and mental health outcomes of children and adolescents, though there is a suggestion that enthusiasm has moved ahead of the evidence base. Most evaluations of MBIs are either uncontrolled or nonrandomized trials. This meta-analysis aims to establish the efficacy of MBIs for children and adolescents in studies that have adopted a randomized, controlled trial (RCT) design. METHODS: A systematic literature search of RCTs of MBIs was conducted up to October 2017. Thirty-three independent studies including 3,666 children and adolescents were included in random effects meta-analyses with outcome measures categorized into cognitive, behavioural and emotional factors. Separate random effects meta-analyses were completed for the seventeen studies (n = 1,762) that used an RCT design with an active control condition. RESULTS: Across all RCTs we found significant positive effects of MBIs, relative to controls, for the outcome categories of Mindfulness, Executive Functioning, Attention, Depression, Anxiety/Stress and Negative Behaviours, with small effect sizes (Cohen's d), ranging from .16 to .30. However, when considering only those RCTs with active control groups, significant benefits of an MBI were restricted to the outcomes of Mindfulness (d = .42), Depression (d = .47) and Anxiety/Stress (d = .18) only. CONCLUSIONS: This meta-analysis reinforces the efficacy of using MBIs for improving the mental health and wellbeing of youth as assessed using the gold standard RCT methodology. Future RCT evaluations should incorporate scaled-up definitive trial designs to further evaluate the robustness of MBIs in youth, with an embedded focus on mechanisms of action

Age and Gender Effects in Sensitivity to Social Rewards in Adolescents and Young Adults

Adolescence is a sensitive period for socio-cultural processing and a vast literature has established that adolescents are exceptionally attuned to the social context. Theoretical accounts posit that the social reward of social interactions plays a large role in adolescent sensitivity to the social context. Yet, to date it is unclear how sensitivity to social reward develops across adolescence and young adulthood and whether there are gender differences. The present cross-sectional study (N = 271 participants, age 11–28 years) examined age and gender effects in self-reported sensitivity to different types of social rewards. In order to achieve this aim, the Dutch Social Reward Questionnaire for Adolescents was validated. Findings revealed that each type of social reward was characterized by distinct age and gender effects. Feeling rewarded by gaining positive attention from others showed a peak in late adolescence, while enjoying positive reciprocal relationships with others showed a linear increase with age. Enjoying cruel behavior toward others decreased with age for girls, while boys showed no changes with age and reported higher levels across ages. Reward from giving others control showed a mid-adolescent dip, while enjoying group interactions did not show any changes with age. Taken together, the results imply that the social reward of social interactions is a nuanced and complex construct, which encompasses multiple components that show unique effects with age and gender. These findings enable us to gain further traction on the ubiquitous effects of the social context on decision-making in adolescent’s lives