A pilot study of CBT for stressed teenagers

Paper presented at 41 World Congress of Behavioural and Cognitive Therapies. Reykjavik, 2011.

Abstract text:
A pilot study of CBT for stressed teenagers There is data indicating that teenagers in high school in Stockholm experience increased level of stress (Schraml et al. 2007). According diathesis-stress model person’s reaction to life stress events depends on interaction between life events and different vulnerability factors. An individual’s reaction to the environment is mediated by the subjective evaluation (i.e., appraisal) of the environment, and the process of coping with a stressful appraised event (Lazarus & Folkman, 1999). Appraisals of situations and coping behaviour are influenced by personal characteristics, such as personality, social skills, and problem-solving skills. The single most important factor that predicts stress vulnerability is neuroticism (Mathews. et. al. 1998). Adolescents with comorbid depression and anxiety reported the highest level of stress generation in their relationships with others. A potential mechanism through which high N, depression and anxiety, may influence stress generation can be a common cognitive vulnerability factor. High N is related to negative self-appraisal, self-critical emotion focused coping and pessimism as explanatory style (Matthews et. al, 1998). There is data pointing to stress-buffering effects of self-enhancing beliefs (Taylor & Lerner, 2003). There is also evidence of a more potent cognitive vulnerability–stress interaction for adolescent girls compared with adolescent boys (Connolly et. al. 2010). The main aim of the present study was to investigate which factors contribute to the experience of stress symptoms and to develop a CBT program to reduce stress among teenagers. We screened 475 first grade high school students, 247 males and 228 females from two schools in a comparable upper middle-class Stockholm suburban area. They answered a stress-screening questionnaire about symptoms of stress, anxiety and depression, life style and self-esteem. The response rate was as high as 93% in both schools. The average age of our sample was 16 years. Girls were significantly more stressed, had more anxiety and depression and lower self-esteem than boys. In Regression analysis the final model explained 60% of variation in stress symptoms. Anxiety accounted for most variance, 36%, gender for 12% and global self-esteem for 9% of variance. The recruitment of participants for the individual CBT treatment was based on high scores in the Shirom- Melamend Burnout Measure (SMBM) (Shirom & Melamed, 2006). Altogether, fourteen extremely stressed individuals were chosen as potential participants in the individual CBT. Finally, five students (all girls) actually joined, followed through and finished the CBT intervention. The other nine high school students, who chose not to join the intervention, didn’t differ significantly on any measure from CBT participants. A 10 weeks individual CBT package consisted of basic stress management, traditional cognitive-behavioural techniques applied to academic and social stress, defeating repetitive thinking style: ruminations and worry, and boostering of self-esteem and defeating perfectionism and unassertiveness (Fenell, & Jenkins, 2004). The CBT participants underwent a pre-treatment assessment of symptoms with Beck Youth Inventory-I (Beck, et.al. 2010). Mean BYI anxiety among CBT participants at pre-treatment was higher than the corresponding mean in a clinical group of teenagers with anxiety disorders (Beck, J. et.al.2010). After completed treatment (approximately 3 month later) and at follow up (approximately 6 month later) they answered the same stress-screening questionnaire as before treatment and Beck Youth Inventory-II (BYI-II). Among CBT participants’ significant reduction of stress, anxiety and depression and increase of self-esteem after treatment were detected. At follow up two patients had slightly heightened anxiety and depression symptoms and a general increase in PBS (Performance-based self-esteem) (Hallsten et al., 2005) was observed. CBT interventions focused on achievement stress and social stress and boostering of self-esteem seem to be promising treatment alternative for stressed teenagers. However, between post treatment and follow up, it was difficult to keep the effect of lowering perfectionism and standards. An important result of this study is that stress reaction among teenagers is mediated by anxiety and that girls were significantly more stressed than boys. A potential value of developing a CBT specifically for girls was discussed.There is need for larger-scale randomized trials and longer follow up intervals. Table 1. Changes in scores from pre-treatment to post-treatment and follow up and effect sizes within group for CBT participants (n=5)

Note. SMBM Shirom-Melamed Burnout Measure , RSE Rosenberg’s self-esteem scale , PBS Performance-based self-esteem, BYI Beck Youth Inventory.

Authors of the Abstract
Makower, Irena, Manowa cognitive therapy and education, Sweden (Presenting); Schraml, K., Stockholms University, Sweden; Perski, A., Stockholms University, Sweden