JMIR Publications

ABSTRACT

Background:

Adolescence is a crucial developmental period characterized by elevated stress and significant mental health challenges, including depression and anxiety. With barriers like stigma, accessibility, and cost hindering effective treatment, leveraging school systems for mental health interventions offers a strategic advantage due to their reach and potential for scalability.

Objective:

This study aimed to investigate the potential of "Project RE-THINK," a single-session, digital thought record intervention delivered in a school setting, designed to improve adolescents' mental health by enabling them to identify, examine, and reframe negative cognitions and enhance emotional well-being.

Methods:

Project RE-THINK helps adolescents to identify, examine, and challenge negative cognitions in order to improve their mental health, as demonstrated through changes in negative cognition and overall emotional valence. Adolescents (N = 1,052) in grades 10-12 enrolled in high school during the 2023-2024 school year completed the online activity. Using a pre/post design, participants read through an example thought record, then completed their own thought record by identifying and describing a recent upsetting situation, and answering a series of questions that allowed them to challenge their negative cognition, as well as learn and utilize emotion regulation skills regarding the upsetting situation. Measures of pre- and post-intervention overall emotional valence and negative cognition were collected in order to determine the intervention’s effect on participants’ mental health.

Results:

Descriptive statistics confirmed that smaller proportions of adolescents endorsed feeling negative emotions, such as anger, shame, anxiety, disgust, guilt, sadness, and fear, after the intervention. Paired samples t-tests showed that adolescents experienced a significant reduction in their belief in their negative cognition from pre- to post-intervention, t(1051) = 27.71, P < .001, d = .85 [.78, .93], which demonstrates that the intervention helped them challenge their negative thoughts about their upsetting situation, as well as significant improvements to their overall emotional valence, t(1051) = -31.85, P < .001, d = -.98 [-1.06, -.91], which demonstrates that the intervention helped them feel better about their upsetting situation. Findings also showed a significant correlation between change in negative cognition and change in overall emotional valence, r = .25, P < .001, supporting our hypothesis that reducing the strength of belief in negative cognitions can help improve one’s emotions. Lastly, ANCOVAs confirmed that there were no significant differences in intervention efficacy by gender, race/ethnicity, or socioeconomic status, thereby substantiating broad intervention efficacy across adolescents from difference backgrounds and experiences.

Conclusions:

Project RE-THINK effectively improved both cognitive and emotional outcomes among adolescents, demonstrating its potential as a scalable, low-cost intervention within school settings. Future studies should explore the longitudinal effects and potential integration of such interventions into regular school curricula to help adolescents learn effective emotions and coping skills as well as to help protect and sustain adolescent mental health.