Adolescence can be an extremely stressful and trying time for young people. Adolescents face significant stressors that include performing well in school, and making decisions that have the potential to influence the rest of their lives. As well as this adolescence is also a period of rapid development and transition. For some adolescents, these stressors can become overwhelming and can contribute to the development of psychological distress. Psychological distress can take many forms. Rates of depression and anxiety in adolescents are estimated at between 10 and 20 per cent. The number of adolescents who experience significant levels of stress is likely to be much higher.
So if this population group are so vulnerable to significant levels of psychological distress, what can be done to prevent or treat it? Psychological research has highlighted several forms of psychotherapy that can be helpful in the treatment of varying forms of adolescent psychological distress. Much of this research has looked at Cognitive Behaviour Therapy (CBT). However one particular form of psychotherapy called Acceptance and Commitment Therapy or ACT for short that is derived from CBT has garnered recent interest.
ACT is considered to be part of a ‘third wave’ of psychotherapy. This new wave differs from traditional CBT approaches in that they are generally more consequence rather than antecedent focused. In other words, these therapies look less to the past and more at the present which means that they require and promote acceptance as a strategy to facilitate change. The incorporation of acceptance and mindfulness strategies allows the individual to become aware of their distressing thoughts, feelings and behaviours to the point where they can tolerate them without needing to change or avoid them. By generating this level of awareness and acceptance, the individual can separate themselves from their negative thoughts, feelings and behaviours which can help to make them unthreatening. This change is driven by a motivation to live a value guided life. In other words, the individual needs to be able to decide what kind of life they want to live, and what values will contribute to this life. By doing this, the individual gains motivation for behaviour change that occurs in a moment-by-moment fashion as they decide how to live by their own values.
In a review of the so called ‘third wave’ of psychotherapies (including ACT) for the treatment of adolescents, psychologists Christopher Bass, Jolene Van Nevel and Joan Stewart concluded that despite its more modest evidence base, ACT shows significant promise for the treatment of a wide range of psychological disorders in adolescents when compared to the well-established CBT. In particular Bass and his colleagues suggested that ACT when aimed towards specific treatment populations, can have better outcomes in terms of treating individuals who were previously resistant to treatment, decreasing levels of treatment drop out, increasing durability of the positive effects of treatment and reducing relapse rates. Bass and his team suggest that ACT’s emphasis on acceptance is the likely cause of these findings. While these authors do not necessarily advocate ACT as being an overall more effective form of psychotherapy when compared to CBT, they do support its use and highlight the need for further research.
As ACT has some catching up to do, research into its’ effectiveness for the treatment of adolescents has been growing exponentially. One example of a recent study is that carried out by a joint team of psychologists from Sweden, Australia and the United States. This team, led by Fredrik Livheim examined the effectiveness of ACT for the treatment of adolescents experiencing symptoms of depression or stress in both Australia and Sweden. Livheim and his team implemented a brief 8 week group programme based on ACT principles into a school setting.
What Livheim and his team found was that when compared to a control group that received standard individual support from the school health department, those in the ACT group experienced significantly better outcomes overall. The main findings of this particular study showed that the Australian ACT group were found to have significant decreases in symptoms of depression while the Swedish ACT group were found to have significant decreases in levels of stress when compared to those who received treatment as usual. What these findings tell us is that ACT can have several benefits, even when delivered in a brief group format. This suggests that ACT might be easily implemented into a school setting for the preventative treatment of psychological distress in adolescents.
In terms of what drives success in ACT, researchers Blake Berryhill and Marcie Lechtenberg suggest that clearly identifying values is a core contributor to better treatment outcome. Berryhill and Lectenberg highlight that the core underlying principle of ACT is to live a rich and meaningful life that is driven by and in sync with what an individual values. Values are differentiated by goals by the fact that they are a guideline for how to live and do not necessarily have an end point. For instance, consider being a good son/daughter as a value but getting along well with one’s parents as a goal. As values direct our behaviour, Berryhill and Lectenberg argue that clearly identifying values is essential for moving adolescents along in treatment.
While this is done early on in formal ACT settings, identifying goals can be completed at home with some careful consideration and support. For instance, if you are the parent of an adolescent, consider how you could help them to identify what their values are and assess to what extent they are currently living to these values. Berryhill and Lectenberg suggest trying to help the adolescent to identify what kind of person they want to be in each domain of their life (e.g. home, school, friends). By doing this, and really focusing on what the adolescent wants to be, you may find that a number of distinct values emerge. Once this happens, you can encourage the adolescent to discuss to what extent they feel that they are currently living to these values. By identifying values and generating an interest for change, you can then encourage the adolescent to behave in a way that fosters these specific values.
With rates of psychological distress in adolescents increasing, more needs to be done to support adolescents already dealing with such distress and also to prevent this distress developing in the first place. ACT serves as a potential solution for both of these issues. By focusing on acceptance and living moment-by-moment in a value-guided manner, ACT may be an extremely beneficial treatment for adolescents experiencing significant psychological distress. As well as this, ACT also has the potential to be used as a preventative tool for young people at risk for such distress. Education support services could benefit from including ACT informed programmes that promote these principles.
Links to the mentioned articles are included here:
The effectiveness of Acceptance and Commitment Therapy for Adolescent Mental Health: Swedish and Australian Pilot Outcomes (Livheim, F., et al., 2014).
Acceptance and Commitment Therapy with Adolescents: Identifying and Clarifying Values (Berryhill, B., & Lechtenberg, M. 2015).
A comparison between DBT, MDT, CBT, and ACT in the treatment of adolescents (Bass, C., et al., 2014).
Ms. Niamh Allen, M.A. B.Sc.