School-Based Adolescent Mental Health: A Focus on Psychological Flexibility and Paranoia

There is growing need for mental health interventions and support in schools, focusing on prevention and early intervention, due to increasing mental health difficulties within the adolescent population. This thesis aims to determine the effectiveness of an existing intervention, and an initial test of a new intervention, delivered in schools.
Section one explores the impact of school-based Acceptance and Commitment Therapy (ACT), specifically focussing on psychological flexibility. Psychological flexibility is the ability to tolerate and accept discomfort, stay present and live in line with values, which can be impacted by mental health difficulties. Six databases were searched systematically, including articles which carried out ACT with a school-based population and measured psychological flexibility. Due to a variety of study designs, three meta-analyses (combining available studies to find an overall effect) were conducted to synthesise the data. The results were mixed, and any changes were small or not meaningful, especially when considering publication bias. The literature was low quality and often contained small samples, which may have impacted the results. The review would suggest that ACT may be effective in some areas, but larger and more robust research trials are needed, with more holistic measurements of psychological flexibility.
Section two explores the impact of a new psychological intervention (TRUST: TReating Unhelpful Suspicious Thoughts in Teenagers) with young people experiencing paranoia, specifically focussing on whether it was acceptable to young people, and feasible to carry out in schools. Six young people from one school in West Yorkshire engaged with the six-session imagery and values-based intervention and completed follow-up data. Participation and engagement in the treatment suggested the treatment was acceptable and feasible. Outcome measures suggested improvements in paranoia, psychological flexibility and negative imagery for five of the six young people. Further research using TRUST would be suitable to explore these outcomes further.