Randomized controlled trial of therapy for teenagers

“These Teens Got Therapy. Then They Got Worse.” (Atlantic, by Olga Khazan; paywalled, but readable in the Google cache):

Researchers in Australia assigned more than 1,000 young teenagers to one of two classes: either a typical middle-school health class or one that taught a version of a mental-health treatment called dialectical behavior therapy, or DBT. After eight weeks, the researchers planned to measure whether the DBT teens’ mental health had improved.

The therapy was based on strong science: DBT incorporates some classic techniques from therapy, such as cognitive reappraisal, or reframing negative events in a more positive way, and it also includes more avant-garde techniques such as mindfulness, the practice of being in the present moment. Both techniques have been proven to alleviate psychological struggles.

The author and editors forgot to capitalize “Science”!

This special DBT-for-teens program also covered a range of both mental-health coping strategies and life skills—which are, again, correlated with health and happiness. One week, students were instructed to pay attention to things they wouldn’t typically notice, such as a sunset. Another, they were told to sleep more, eat right, and exercise. They were taught to accept unpleasant things they couldn’t change, and also how to distract themselves from negative emotions and ask for things they need. “We really tried to put the focus on, how can you apply some of this stuff to things that are happening in your everyday lives already?” Lauren Harvey, a psychologist at the University of Sydney and the lead author of the study, told me.

But what happened was not what Harvey and her co-authors predicted. The therapy seemed to make the kids worse. Immediately after the intervention, the therapy group had worse relationships with their parents and increases in depression and anxiety. They were also less emotionally regulated and had less awareness of their emotions, and they reported a lower quality of life, compared with the control group.

Most of these negative effects dissipated after a few months, but six months later, the therapy group was still reporting poorer relationships with their parents.

Last year, a study of thousands of British kids who were put through a mindfulness program found that, in the end, they had the same depression and well-being outcomes as the control group. A cognitive-behavioral-therapy program for teens had similarly disappointing results—it proved no better than regular classwork.


5 thoughts on “Randomized controlled trial of therapy for teenagers

  1. One would expect the psychology boffins to be aware of (psychological) reactance. Which is particularly strong in teenagers.

    The modern Science(tm) is a playground for half-educated incompetents.

  2. “Immediately after the intervention, the therapy group had worse relationships with their parents.” Maybe therapy helped them become more aware of how dysfunctional their parents were.

    • Good therapy should help people have better relationships even with dysfunctional parents.

      What good is realizing it, as you hypothesize, if it doesn’t improve.

    • PhilH: Divorce litigators have noted an association between a person being in therapy (individual psychotherapy, not “couples therapy” or “marriage counseling”) and a person deciding to file a divorce lawsuit. In therapy, the customer learns that his/her/zir/their happiness is more important than anyone else’s and that his/her/zir/their self-interest can reasonably be acted in without considering the effect on others, e.g., children. The therapy acts as a disinhibitor for what were previously taboo behaviors. Consider the 40-year-old man who goes to a community gathering with his 40-year-old wife and their 4 young kids. The guy says to a small group “my wife is fat and fatigued from these kids so she doesn’t have a lot of energy for sex. I want to unload her via no-fault divorce, pay whatever state law requires, and bang a different 22-year-old from Tinder every other night.” Will anyone in the group of middle-aged married people affirm his truth? Not likely! Suppose, on the other hand, that he is paying a therapist $150/hour and says the same thing. Will the therapist tell him that this desire is immoral and that he must stay with the wife and kids?

    • @philg if it’s a 40 year old woman complaining about a man, you bet her peers will cheer her on!

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