Young people are at high risk for mental health disorders (Kesslerk et al., 2007), and it is estimated that around 20% of youths globally experience a mental health issue (Kieling et al., 2011; World Health Organization, 2003). Mental health disorders can have a lasting impact on youth’s functioning and increase the risk of developing additional mental health issues in adulthood. For example, young people with a psychological disorder are at risk for poor academic performance or other school functioning (e.g., leaving school early). Furthermore, they have an increased risk of developing depression, anxiety, substance use, and another disorder in adulthood (Arslan, 2020; Copeland et al., 2009; Costello et al., 2003; Kesslerk et al., 2007). Despite clinical frameworks emphasizing the diagnosis and treatment of individu-als’ mental health problems, it has been highlighted that the importance of develop-ing prevention-based approaches (e.g., public health) to reduce the prevalence and impact of youth mental health problems (Arslan & Coşkun, 2023; Renshaw et al., 2023). Especially, schools play an essential role in offering mental health programs for young people in non-clinical settings, as they provide safe, cost-effective, and adaptable environments where a wide variety of interventions can be implemented (Knight & Samuel, 2022). Therefore, by employing the principles and methodolo-gies of ACT theory across different levels, namely universal, small-group, and indi-vidual, within the multi-tiered system of supports (MTSS) framework, mental health providers have the opportunity to integrate novel strength-based and develop-mental approaches (Arora et al., 2019; Beck et al., 2021). These approaches can effectively promote youth mental health and well-being. Although the body of literature on ACT in school settings is relatively new and expanding, the existing literature provides clear documentation and endorsement of ACT as a powerful approach for implementation in schools and with children and adolescents. For example, in a study by Hancock et al. (2018), the effectiveness of ACT, cognitive-behavioral therapy (CBT), and a waitlist control (WLC) for anxiety in children and adolescents was compared. The study found no significant differ-ences between the ACT and CBT conditions, but both treatments were more effec-tive than the waitlist (Hancock et al., 2018). In relation to depression, a study investigated the effectiveness of ACT as a treatment for depression in adolescents. The study indicated that after treatment, 58% of participants in the ACT condition reported clinically significant reductions in their depressive symptoms compared to treatment as usual (TAU). Furthermore, the 3-month follow-up suggested that the magnitude of improvement increased, although the number of participants was small (Hayes et al., 2011). Similarly, Livheim et al. (2015) examined the effect of a brief intervention based on the principles of ACT on depressive symptoms and stress among adolescents. The study found that adolescents in the ACT-intervention group, when compared to the control group, reported lower levels of depressive symptoms and stress with a large effect size, and marginally significant decrease of anxiety, and marginally significant increased mindfulness skills (Livheim et al., 2015). In another randomized controlled trial comparing ACT + a stable selective serotonin reuptake inhibitor (SSRI), group CBT + SSRIs, and SSRIs-only in adoles-cents with obsessive-compulsive disorder (OCD), there was a 29.4% reduction in obsessive-compulsive symptoms at post-treatment and a 21.8% reduction at follow-up in the ACT + SSRIs condition, but no divergences between ACT and CBT condi-tions. Moreover, the ACT + SSRI condition indicated significant improvement in mindfulness, psychological flexibility, and valued living that were maintained at follow-up compared to the CBT+SSRI and continued SSRIs (Shabani et al., 2019). Although there are encouraging findings supporting the utilization of ACT as an intervention in school settings, there is a need for more robust studies with larger and diverse sample sizes that directly compare ACT to other active treatments.
Approximately 75% of the studies published on the use of ACT-based approaches with young people focus on interventions conducted in clinical settings, predomi-nantly in one-on-one formats (Petersen et al., 2023; Swain et al., 2015). However, the applications of ACT extend well beyond clinical settings and should be imple-mented in the natural environments where children develop, such as schools settings (Petersen et al., 2023). With this goal in mind, Burckhardt et al. (2016) sought to improve the current body of research by evaluating the additional advantages of integrating an ACT component into a school-based mental health program that com-bines positive psychology with ACT, known as Strong Minds. Strong Minds com-prised of a series of 16 half-hour sessions conducted in the school auditorium (Burckhardt et al., 2016). The program commenced with sessions focusing on the six fundamental aspects of psychological flexibility: present moment awareness, defusion, acceptance, self-as-context, values, and committed action (Hayes et al., 1999). A randomized controlled trial involving 267 high school students in grades 10–11 revealed that, when compared to the control group receiving education as usual, tenth-grade adolescents who participated in the Strong Minds program exhib-ited statistically significant reductions in depression, anxiety, and stress, along with improvements in subjective well-being. However, interestingly, the eleventh-grade students who took part in the intervention did not experience these same benefits in comparison to the control group (Burckhardt et al., 2016).
Like Burckhardt et al. (2016) and Pahnke et al. (2014) evaluated the effectiveness of a 6-week group-based ACT in improving internalizing problems, externalizing problems, prosocial behaviors, anger, stress, and peer relationship problems in high- functioning students with autism spectrum disorder (aged 13–21 years). In this pilot study, a quasi-experimental design was utilized to compare the ACT group partici-pants with a control group receiving education as usual. Specifically, 28 high- functioning adolescent students with ASD from six classrooms across two schools were assigned to either the treatment or control group based on their current class grouping. The intervention consisted of a structured 6-week program, with sessions held twice weekly for 40 min each. Overall, the ACT intervention demonstrated statistically significant improvements in self- and teacher-reported levels of stress compared to the education-as-usual control group. Teacher-reported hyperactivity and prosocial behaviors also displayed meaningful improvements in the treatment group relative to the control, although self-reported outcomes in these areas did not differ significantly between the groups. Self-reported levels of anxiety, depression, and anger significantly improved in the ACT group compared to the control group.
A school-based study by Dixon et al. (2022) evaluated the effectiveness of the ACT-based curriculum when implemented in a public school setting. The interven-tion involved the implementation of the AIM curriculum (Paliliunas et al., 2018). The curriculum consisted of a total of 175 ACT lessons, organized into 5-day mod-ules centered around specific themes. Each of these lessons was designed to be implemented at different levels of intensity. Tier 1 provided a brief general overview statement and introduced a themed message related to one of ACT’s six psychologi-cal flexibility processes. This was typically conveyed through a few sentences con-taining metaphors or concepts for the students to reflect on throughout the school day. Tier 2 built upon the previous narrative by providing additional content to fos-ter discussion among students or between the teacher and student. Tier 3 delved even deeper into the concepts, often including directives for writing, engaging in artwork, facilitating further discussions, or expanding on the metaphorical theme in various ways. The overarching approach of the AIM program was to deliver Tier 1 to all students as a preventative mindfulness-based approach. Tiers 2 and 3, on the other hand, were specifically targeted for students identified as needing additional support due to a history of aggressive behavior, social and emotional challenges, or related developmental disabilities. The findings indicated that by the end of the school year, students demonstrated improvements in psychological flexibility and mindfulness. Additionally, state standardized testing scores showed overall increases compared to the previous 2 years within the entire school (Dixon et al., 2022). In another study, Yapan et al. (2021) aimed to examine the effect of the ACT-based intervention on test anxiety and compare its effectiveness with traditional CBT. The study was conducted in a pre-experimental design with high school students receiv-ing ACT, CBT, and a control group. While the control group received no interven-tion, participants in the ACT group received seven sessions and the CBT group received eight sessions. Sessions included creative hopelessness, acceptance, cogni-tive defusion, flexible contact with the present moment, values, and value-focused behavioral interventions. The CBT program included traditional interventions such as cognitive restructuring and relaxation techniques. Results indicated that both ACT and CBT intervention effects on reducing test anxiety for 1 and 3 months fol-low-up. Overall, considering the existing literature supporting the applications of ACT-based interventions in schools, it is evident that these interventions hold sig-nificant promise for promoting positive outcomes in various areas of students’ lives, including mental health, well-being, academic performance, and social-emotional development.
Conclusions and Future Directions
This chapter reviewed the utilization of ACT as a school-based intervention for fostering student mental health. While ACT has been implemented in diverse school settings to assist students in enhancing their mental health and well-being, further research is required to enhance the implementation of ACT-related processes in schools. In schools, ACT is often delivered through group sessions, where students are taught to understand their thoughts and emotions and to accept them as they are, rather than trying to avoid or control them. ACT has been shown to be effective in reducing symptoms of anxiety, depression, and stress in students, as well as in improving their academic performance and behavior in the school settings. However, it is crucial to conduct additional research to gain a deeper understanding of the efficacy of ACT for young people facing mental health challenges in schools (Arslan, 2024). Furthermore, investing in further research on preventative programs based on ACT models could be advantageous for youth populations. Implementing ACT in schools can help to promote a positive school culture and support the overall mental health and well-being of students and staff.
As another potential future direction, this chapter suggests the expansion of ACT in schools to enhance its ability to promote mental health and well-being by extend-ing its reach to include teachers and other educators. This review on ACT in schools focused exclusively on studies with youths yet ACT may provide a consistent approach that can support the well-being of both teachers and parents in school set-tings (e.g., Paliliunas et al., 2023; Whittingham & Coyne, 2019). ACT, with its focus on psychological flexibility and values-based action, offers a unique approach to address the challenges faced by educators. Some studies have demonstrated the efficacy of ACT-based interventions in reducing stress, burnout, and psychological distress among teachers (Biglan et al., 2013; Jeffcoat & Hayes, 2012; Paliliunas et al., 2023). Moreover, ACT-based interventions have shown promising results in improving mindful awareness, sense of efficacy, valued living, and overall well- being of teachers (Biglan et al., 2013; Ghasemi et al., 2023). Given the demanding nature of the teaching profession, ACT interventions tailored for educators may play a crucial role in supporting their mental health and enhancing their profes-sional fulfillment. Further research is needed to explore the long-term effects and sustainability of ACT interventions for teachers and to identify specific strategies that can effectively integrate ACT principles into the school context. Similar to the notion suggesting the application of ACT to teachers and other educators, ACT-based interventions in school settings can prove effective in reduc-ing parental stress, improving parenting skills, and enhancing overall parental well- being (Byrne et al., 2021; Whittingham & Coyne, 2019). These interventions often incorporate mindfulness practices, acceptance of difficult thoughts and emotions, and the identification and clarification of personal values related to parenting (Byrne et al., 2021). By fostering psychological flexibility, parents can develop more adap-tive ways of responding to the challenges of parenting, reduce parental burnout, and enhance the quality of parent–child relationships. Further research is necessary to explore the effectiveness of school-based ACT interventions for parents, determine the most optimal methods of delivering ACT-based parenting programs, and assess the long-term impacts on parental well-being and child outcomes. Overall, ACT holds promise as an approach to support and enhance the well-being of both teach-ers and parents, thereby benefiting students. However, it would be beneficial to focus on specifically examining the unique contributions of ACT compared to other existing evidence-based practices (e.g., CBT) in promoting teacher functioning, mental health, and well-being.