Targeting Psychological Flexibility in Youth to Enhance Health-Related Behaviors

Abstract

Background: Adolescents are uniquely vulnerable to a wide range of psychological issues and often, concerns inadequately addressed. When addressed, mental health concerns are commonly handled in schools, which are uniquely positioned to prevent social and emotional difficulties. Universal, social and emotional learning curricula have demonstrated efficacy within a framework providing multi-tiered systems of support and represent promising methods for addressing youth mental health with a broad scope. Unfortunately, implementation of social emotional learning curricula presents multiple barriers to implementation and limited understanding of the processes of change, necessary procedures, relevant contextual variables, and differential impact of curricula on positive student functioning with high school students. Traditional models used to address mental health in adolescents often take a deficit-oriented approach. An emerging developmental model of behavior change incorporates principles of Acceptance and Commitment Therapy, Positive Psychology, Behaviorism, Relational Frame Theory, and Evolution Science to target functional classes of behavior and facilitate health-promoting behaviors in youth. Purpose: The present study is a preliminary investigation examining the feasibility, acceptability, efficacy, participant characteristics (e.g., trait mindfulness), and processes of change (e.g., psychological inflexibility) associated with a universal preventive intervention based on a process-oriented, developmental model of behavior change targeting health-promoting behaviors. Method: Students (n = 118) were recruited from 6 Health/PE classes in a rural, underserved high school. The participant sample consisted of 48% African-American/Black, 27% Hispanic/Latino, 22% Caucasian/White, and 3% American Indian/Native American. Almost all (i.e., 96%) of participants reported receiving free or reduced lunch. Participants were assigned to an enhanced Health/PE condition or a comparison condition. Participants in the enhanced Health/PE condition received 6 weeks of a universal preventive intervention targeting social and emotional learning skills, sleep, and physical activity. Results: The enhanced Health/PE curriculum was feasibly implemented with satisfaction from students and teachers. Participants in the enhanced curriculum did not exhibit significant changes in psychological inflexibility, sleep hygiene, or physical activity from baseline to post-intervention; however, changes in amount of time engaging in physical activity were present at one-year follow-up relative to the comparison condition. Trait mindfulness did not moderate the relationship between condition assignment and treatment outcomes. Psychological inflexibility did not mediate the relationship between condition assignment and health-related outcomes. Post-hoc analyses indicated no significant differences between pre- and post-test psychological inflexibility scores for students with clinically significant ratings. Due to a relatively small number of participants (n = 14) meeting the clinically significant cutoff on the AFQY-8 (total score of at least 15), post hoc analyses of these participants were conducted to determine potential differential impact from programming. Nine participants in the DNA-v-PE condition and four in the comparison condition exhibited clinically significant ratings of psychological inflexibility at baseline. Independent samples t-tests were conducted to compare pre- and post-scores of psychological inflexibility for both groups. Participant pre-test scores (M = 17.79, SD = 2.99) did not differ significantly from post-test scores (M = 13.15, SD = 8.55), t(25) = 1.91, p = .07, d = .73, 95% CI [-.05, 1.51). Pre and post scores were also compared within conditions. DNA-v-PE participants pre-test scores (M = 17.56, SD = .82) did not differ significantly from post-test scores (M = 14.44, SD = 9.29), t(16) = .97, p = .35, d = .46, 95% CI [-.49, 1.39]. Comparison condition participants pre-test scores (M = 18.2, SD = 1.83) did not differ significantly from post-test scores (M = 10.25, SD = 6.8), t(7) = 2.19, p = .07, d = 1.47, 95% CI [-.09, 2.94). Results indicate both conditions exhibited non-significant reductions in psychological inflexibility from baseline to post-intervention. Notably, although there were non-significant changes in scores for participants in the either condition, changes were associated with a large effect (i.e., Cohen's d > .8) in the comparison condition and a small to medium effect in the DNA-v-PE condition. Discussion: Findings were reviewed in the context of research and clinical implications of process-oriented, social and emotional learning curricula and the importance of evaluating contextual variables, and moderators and mediators of treatment. Practical implications of conducting universal preventive interventions in schools and limitations of the current study are discussed.