Skip to main content

Advertisement

SpringerLink
Log in

The Effectiveness of Acceptance and Commitment Therapy for Adolescent Mental Health: Swedish and Australian Pilot Outcomes

  • Original Paper
  • Published:
Journal of Child and Family Studies Aims and scope Submit manuscript

Abstract

Depression, anxiety and stress are common problems among adolescents. Teaching young people coping strategies in school-based intervention programs is one promising approach hoped to remedy the negative consequences of distress in adolescence. The aim of the two pilot studies was to examine the effect of a brief intervention based on the principles of Acceptance and Commitment Therapy (ACT) on depressive symptomatology (Australian study, N = 66) and stress (Swedish study, N = 32) among adolescents screened for psychosocial problems in school settings. In both studies, subjects were assigned to receive the ACT-group-intervention, or a control intervention featuring individual support from the school health care. The Australian study was a planned comparison, with random allocation for girls, plus one replication of a boys group. The Swedish study used a randomized controlled design. The ACT-intervention was an 8-session manualized group program. The Australian study showed significant reductions in depressive symptoms with a large effect, and significant reductions in psychological inflexibility with a medium effect when compared to the control group who received standard care. In the Swedish study, the ACT-intervention group, when compared to the control group, reported significantly lower levels of stress with a large effect size, and marginally significant decrease of anxiety, and marginally significant increased mindfulness skills. Taken together, the ACT-intervention seems to be a promising intervention for reducing stress and depressive symptoms among young adolescents in school and should be tested in full-sized studies. Limitations of these two pilots include small samples.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  • Bethay, J. S., Wilson, K. G., Schnetzer, L. W., Nassar, S. L., & Bordieri, M. J. (2013). A controlled pilot evaluation of acceptance and commitment training for intellectual disability staff. Mindfulness, 4(2), 113–121. doi:10.1007/s12671-012-0103-8.

    Article  Google Scholar 

  • Biglan, A., Hayes, S. C., & Pistorello, J. (2008). Acceptance and commitment: Implications for prevention science. Prevention Science, 9(3), 139–152. doi:10.1007/s11121-008-0099-4.

    Article  PubMed Central  PubMed  Google Scholar 

  • Bond, F. W., & Bunce, D. (2000). Mediators of change in emotion-focused and problem-focused worksite stress management interventions. Journal of Occupational Health Psychology, 5(1), 156–163. doi:10.1037//1076-8998.5.1.156.

    Article  PubMed  Google Scholar 

  • Brinkborg, H., Michanek, J., Hesser, H., & Berglund, G. (2011). Acceptance and commitment therapy for the treatment of stress among social workers: A randomized controlled trial. Behaviour Research and Therapy, 49(6–7), 389–398. doi:10.1016/j.brat.2011.03.009.

    Article  PubMed  Google Scholar 

  • Brown, T. A., Chorpita, B. F., Korotitsch, W., & Barlow, D. H. (1997). Psychometric properties of the Depression Anxiety Stress Scales (DASS) in clinical samples. Behaviour Research and Therapy, 35(1), 79–89. doi:10.1016/s0005-7967(96)00068-x.

    Article  PubMed  Google Scholar 

  • Brown, K. W., & Ryan, R. M. (2003). The benefits of being present: Mindfulness and its role in psychological well-being. Journal of Personality and Social Psychology, 84(4), 822–848. doi:10.1037/0022-3514.84.4.822.

    Article  PubMed  Google Scholar 

  • Calear, A. L., & Christensen, H. (2010). Systematic review of school-based prevention and early intervention programs for depression. Journal of Adolescence, 33(3), 429–438. doi:10.1016/j.adolescence.2009.07.004.

    Article  PubMed  Google Scholar 

  • Campbell, A., Walker, J., & Farrell, G. (2003). Confirmatory factor analysis of the GHQ-12: Can I see that again? Australian and New Zealand Journal of Psychiatry, 37(4), 475–483. doi:10.1046/j.1440-1614.2003.01208.x.

    Article  PubMed  Google Scholar 

  • Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Hillsdale, NJ: Erlbaum.

    Google Scholar 

  • Cohen, S., & Janicki-Deverts, D. (2012). Who’s stressed? Distributions of psychological stress in the United States in probability samples from 1983, 2006, and 2009. Journal of Applied Social Psychology, 42(6), 1320–1334. doi:10.1111/j.1559-1816.2012.00900.x.

    Article  Google Scholar 

  • Cohen, S., Kessler, R. C., & Underwood Gordon, L. (1995). Measuring stress: A guide for health and social scientists. New York, NY: Oxford University Press.

    Google Scholar 

  • Duckworth, A. L., Kim, B., & Tsukayama, E. (2013). Life stress impairs self-control in early adolescence. Frontiers in Psychology, 3, 608. doi:10.3389/fpsyg.2012.00608.

    Article  PubMed Central  PubMed  Google Scholar 

  • Eskin, M., & Parr, D. (1996). Introducing a Swedish version of an instrument measuring mental stress (Reports from the Department of Psychology, No. 813). Stockholm, Sweden: Stockholm University.

  • Flaxman, P. E., & Bond, F. W. (2010a). A randomised worksite comparison of acceptance and commitment therapy and stress inoculation training. Behaviour Research and Therapy, 48(8), 816–820. doi:10.1016/j.brat.2010.05.004.

    Article  PubMed  Google Scholar 

  • Flaxman, P. E., & Bond, F. W. (2010b). Worksite stress management training: Moderated effects and clinical significance. Journal of Occupational Health Psychology, 15(4), 347–358. doi:10.1037/a0020522.

    Article  PubMed  Google Scholar 

  • Flay, B. R., Biglan, A., Boruch, R. F., Castro, F. G., Gottfredson, D., Kellam, S., et al. (2005). Standards of evidence: Criteria for efficacy, effectiveness and dissemination. Prevention Science, 6(3), 151–175. doi:10.1007/s11121-005-5553-y.

    Article  PubMed  Google Scholar 

  • Gao, F., Luo, N., Thumboo, J., Fones, C., Li, S. C., & Cheung, Y. B. (2004). Does the 12-item General Health Questionnaire contain multiple factors and do we need them? Health and Quality of Life Outcomes, 2, 63. doi:10.1186/1477-7525-2-63.

    Article  PubMed Central  PubMed  Google Scholar 

  • Goodman, R. (2001). Psychometric properties of the strengths and difficulties questionnaire. Journal of the American Academy of Child and Adolescent Psychiatry, 40(11), 1337–1345. doi:10.1097/00004583-200111000-00015.

    Article  PubMed  Google Scholar 

  • Goodman, R., Meltzer, H., & Bailey, V. (2003). The strengths and difficulties questionnaire: A pilot study on the validity of the self-report version. International Review of Psychiatry, 15(1–2), 173–177. doi:10.1080/0954026021000046137.

    Article  PubMed  Google Scholar 

  • Grant, K. E., Compas, B. E., Thurm, A. E., McMahon, S. D., & Gipson, P. Y. (2004). Stressors and child and adolescent psychopathology: Measurement issues and prospective effects. Journal of Clinical Child & Adolescent Psychology, 33(2), 412–425. doi:10.1207/s15374424jccp3302_23.

    Article  Google Scholar 

  • Greco, L. A., Baer, R. A., & Lambert, W. (2008). Psychological inflexibility in childhood and adolescence: Development and evaluation of the Avoidance and Fusion Questionnaire for Youth. Psychological Assessment, 20(2), 93–102. doi:10.1037/1040-3590.20.2.93.

    Article  PubMed  Google Scholar 

  • Hankin, B. L., Mermelstein, R., & Roesch, L. (2007). Sex differences in adolescent depression: Stress exposure and reactivity models. Child Development, 78(1), 279–295. doi:10.1111/j.1467-8624.2007.00997.x.

    Article  PubMed  Google Scholar 

  • Hayes, L. L., Boyd, C. P., & Sewell, J. (2011). Acceptance and commitment therapy for the treatment of adolescent depression: A pilot study in a psychiatric outpatient setting. Mindfulness, 2(2), 86–94. doi:10.1007/s12671-011-0046-5.

    Article  Google Scholar 

  • Hayes, S. C., Luoma, J. B., Bond, F. W., Masuda, A., & Lillis, J. (2006). Acceptance and commitment therapy: Model, processes and outcomes. Behaviour Research and Therapy, 44(1), 1–25. doi:10.1016/j.brat.2005.06.006.

    Article  PubMed  Google Scholar 

  • Hayes, L. L., & Rowse, J. (2008). Acceptance and commitment therapy: Experiential adolescent group. Retrieved from Association for Contextual Behavioral Science website: http://contextualpsychology.org/treatment_protocols.

  • Hayes, S. C., & Strosahl, K. D. (Eds.). (2004). A practical guide to acceptance and commitment therapy. New York, NY: Springer.

    Google Scholar 

  • Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (2012). Acceptance and commitment therapy: The process and practice of mindful change (2nd ed.). New York, NY: Guilford Press.

    Google Scholar 

  • Heffner, M., Sperry, J., Eifert, G. H., & Detweiler, M. (2002). Acceptance and commitment therapy in the treatment of an adolescent female with anorexia nervosa: A case example. Cognitive and Behavioral Practice, 9(3), 232–236. doi:10.1016/s1077-7229(02)80053-0.

    Article  Google Scholar 

  • Hewitt, P. L., Flett, G. L., & Mosher, S. W. (1992). The perceived stress scale: Factor structure and relation to depression symptoms in a psychiatric sample. Journal of Psychopathology and Behavioral Assessment, 14(3), 247–257. doi:10.1007/BF00962631.

    Article  Google Scholar 

  • Horowitz, J. L., Garber, J., Ciesla, J. A., Young, J. F., & Mufson, L. (2007). Prevention of depressive symptoms in adolescents: A randomized trial of cognitive-behavioral and interpersonal prevention programs. Journal of Consulting and Clinical Psychology, 75(5), 693–706. doi:10.1037/0022-006x.75.5.693.

    Article  PubMed  Google Scholar 

  • Jakobsson, C., & Wellin, J. (2006). Acceptance and commitment therapy and stress in school: A two year follow up of a randomized controlled trial (Master′s thesis, Uppsala University, Sweden). Retrieved from http://www.livskompass.se/wp-content/uploads/2012/11/act-stress-i-skolan-2arsuppfoljning.pdf.

  • Keenan-Miller, D., Hammen, C. L., & Brennan, P. A. (2007). Health outcomes related to early adolescent depression. Journal of Adolescent Health, 41(3), 256–262. doi:10.1016/j.jadohealth.2007.03.015.

    Article  PubMed  Google Scholar 

  • Livheim, F. (2004). Acceptance and commitment therapy in school setting: To cope with stress, a randomized controlled trial (Master′s thesis, Uppsala University, Sweden). Retrieved from http://www.livskompass.se/wp-content/uploads/2012/11/act-i-skolan-2004.pdf.

  • Merry, S. N., Hetrick, S. E., Cox, G. R., Brudevold-Iversen, T., Bir, J. J., & McDowell, H. (2011). Psychological and educational interventions for preventing depression in children and adolescents. Cochrane Database of Systematic Reviews, 2011(12), Art. No.: CD003380. doi:10.1002/14651858.CD003380.pub3.

  • Merry, S. N., McDowell, H., Hetrick, S., Bir, J., & Muller, N. (2004). Psychological and/or educational interventions for the prevention of depression in children and adolescents. Cochrane Database of Systematic Reviews, Art. No.: CD003380. doi:10.1002/14651858.CD003380.pub2.

  • Merry, S. N., & Spence, S. H. (2007). Attempting to prevent depression in youth: A systematic review of the evidence. Early Intervention in Psychiatry, 1(2), 128–137. doi:10.1111/j.1751-7893.2007.00030.x.

    Article  Google Scholar 

  • Metzler, C. W., Biglan, A., Noell, J., Ary, D. V., & Ochs, L. (2000). A randomized controlled trial of a behavioral intervention to reduce high-risk sexual behavior among adolescents in STD clinics. Behavior Therapy, 31(1), 27–54. doi:10.1016/s0005-7894(00)80003-9.

    Article  Google Scholar 

  • Montazeri, A., Hole, D. J., Milroy, R., McEwen, J., & Gillis, C. R. (2004). Does knowledge of cancer diagnosis affect quality of life? A methodological challenge. BMC Cancer, 4(21). doi:10.1186/1471-2407-4-21.

  • Mrazek, P. J., & Haggerty, R. J. (1994). Reducing risks for mental disorders: Frontiers for preventive intervention research. Washington, DC: National Academies Press.

    Google Scholar 

  • Muris, P., Meesters, C., Eijkelenboom, A., & Vincken, M. (2004). The self-report version of the strengths and difficulties questionnaire: Its psychometric properties in 8- to 13-year-old non-clinical children. British Journal of Clinical Psychology, 43(4), 437–448. doi:10.1348/0144665042388982.

    Article  PubMed  Google Scholar 

  • Neto, F. (1993). The satisfaction with life scale: Psychometric properties in an adolescent sample. Journal of Youth and Adolescence, 22(2), 125–134. doi:10.1007/BF01536648.

    Article  Google Scholar 

  • Ost, L.-G. (2008). Efficacy of the third wave of behavioral therapies: A systematic review and meta-analysis. Behaviour Research and Therapy, 46(3), 296–321. doi:10.1016/j.brat.2007.12.005.

    Article  PubMed  Google Scholar 

  • Parker, G., & Roy, K. (2001). Adolescent depression: A review. Australian and New Zealand Journal of Psychiatry, 35(5), 572–580. doi:10.1046/j.1440-1614.2001.00934.x.

    Article  PubMed  Google Scholar 

  • Pavot, W., & Diener, E. (1993). Review of the satisfaction with life scale. Psychological Assessment, 5(2), 164–172. doi:10.1037/1040-3590.5.2.164.

    Article  Google Scholar 

  • Politi, P. L., Piccinelli, M., & Wilkinson, G. (1994). Reliability, validity and factor structure of the 12-item General Health Questionnaire among young males in Italy. Acta Psychiatrica Scandinavica, 90(6), 432–437. doi:10.1111/j.1600-0447.1994.tb01620.x.

    Article  PubMed  Google Scholar 

  • Powers, M. B., Vording, M. B. Z. V. S., & Emmelkamp, P. M. G. (2009). Acceptance and commitment therapy: A meta-analytic review. Psychotherapy and Psychosomatics, 78(2), 73–80. doi:10.1159/000190790.

    Article  PubMed  Google Scholar 

  • Rao, U., Hammen, C., Ortiz, L. R., Chen, L. A., & Poland, R. E. (2008). Effects of early and recent adverse experiences on adrenal response to psychosocial stress in depressed adolescents. Biological Psychiatry, 64(6), 521–526. doi:10.1016/j.biopsych.2008.05.012.

    Article  PubMed Central  PubMed  Google Scholar 

  • Reynolds, W. M. (2002). Reynold’s adolescent depression scale-2nd Edition: Professional manual. Lutz, FL: Psychological Assessment Resources.

    Google Scholar 

  • Reynolds, W. M. (2010). Reynolds Adolescent Depression Scale. In I. B. Weiner & W. E. Craighead (Eds.), The corsini encyclopedia of psychology. Hoboken, NJ: Wiley.

    Google Scholar 

  • Rosenthal, R., & Rosnow, R. L. (1991). Essentials of behavioral research: Methods and data analysis (2nd Ed.): New York, NY: McGraw-Hill.

  • Rosnow, R. L., Rosenthal, R., & Rubin, D. B. (2000). Contrasts and correlations in effect-size estimation. Psychological Science, 11(6), 446–453. doi:10.1111/1467-9280.00287.

    Article  PubMed  Google Scholar 

  • Statistics Sweden. (2010). Undersökningarna av barns levnadsförhållanden [The surveys of children’s living conditions]. Pressrelease from SCB 16/08/10. No. 2010:209: Retrieved from Statistics Sweden: http://www.scb.se/Pages/PressRelease_298563.aspx.

  • Theodore-Oklota, C., & Orsillo, S. (2011). A mindfulness-based program aimed at reducing the impact of relational aggression. Paper presented at 2011 Association for Contextual Behavioral Science Annual World Conference 9, Parma, Italy.

  • Verbeke, G., & Molenberghs, G. (2000). Linear mixed models for longitudinal data. New York, NY: Springer.

    Google Scholar 

  • Wackerly, D., Mendenhall, W., & Scheaffer, R. L. (2008). Mathematical statistics with applications (7th ed.). Belmont, CA: Thomson Learning.

    Google Scholar 

  • Wicksell, R. K., Melin, L., Lekander, M., & Olsson, G. L. (2009). Evaluating the effectiveness of exposure and acceptance strategies to improve functioning and quality of life in longstanding pediatric pain. A randomized controlled trial. Pain, 141(3), 248–257. doi:10.1016/j.pain.2008.11.006.

    Article  PubMed  Google Scholar 

  • Wilson, K. G., & Murrell, A. R. (2002). ACT for LIFE (Lifting Individuals for Future Endeavors): A treatment manual for at-risk youth. Retrieved from Association for Contextual Behavioral Sciences website: http://contextualscience.org/files/ACT_for_Life_Protocol_2_12_03%5B1%5D_0.pdf.

  • World Health Organization. (2011). Young people: Health risks and solutions. (Fact sheet No. 345). Retrieved from World Health Organization website: http://www.who.int/mediacentre/factsheets/fs345/en/index.html.

  • World Medical Association. (2008). Declaration of Helsinki: Ethical principle for medical research involving human subjects. Retrieved from http://www.healthscience.net/resources/declaration-of-helsinki/.

Download references

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden

    Fredrik Livheim & Anders Tengström

  2. Forum, Norra Stationsgatan 69, floor 7, 113 64, Stockholm, Sweden

    Fredrik Livheim

  3. Orygen Youth Health Research Centre, Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia

    Louise Hayes

  4. Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden

    Ata Ghaderi

  5. Department of Psychology, Uppsala University, Uppsala, Sweden

    Thora Magnusdottir & Anna Högfeldt

  6. Ballarat Health Services, Ballarat, VIC, Australia

    Julie Rowse & Simone Turner

  7. Department of Psychology, University of Nevada, Reno, NV, USA

    Steven C. Hayes

Authors
  1. Fredrik Livheim
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Louise Hayes
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ata Ghaderi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Thora Magnusdottir
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Anna Högfeldt
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Julie Rowse
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Simone Turner
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Steven C. Hayes
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Anders Tengström
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Fredrik Livheim.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Livheim, F., Hayes, L., Ghaderi, A. et al. The Effectiveness of Acceptance and Commitment Therapy for Adolescent Mental Health: Swedish and Australian Pilot Outcomes. J Child Fam Stud 24, 1016–1030 (2015). https://doi.org/10.1007/s10826-014-9912-9

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10826-014-9912-9

Keywords

Search

Navigation