Can we teach CBT in the classroom?
Blindboy Boatclub’s recent podcasts have reopened the debate on teaching Cognitive Behavioural Therapy skills in the classroom. Latest policy changes and research show that it’s not a question of whether we should teach it to teenagers, but whether we can.
Blindboy Boatclub (of the Rubber Bandits) has released a set of thought-provoking podcasts explaining the value of cognitive behavioural therapy (CBT). He highlights the importance of psychological flexibility — the ability to expand our own narrative to understand complex situations and learn to live with uncertainty. He also does an excellent job of explaining issues like negative automatic thoughts and how to work through them. (Rather than explain CBT ideas in detail in this article, I’d recommend listening to at least one of the podcasts which can be found here.)
Blindboy’s argument in favour of teaching CBT skills in schools is a compelling one. Many people learn skills in one-to-one CBT sessions that they bring to future situations to prevent having mental health problems down the line. If CBT skills could be taught in schools, it could potentially improve youth mental health. However, the research on this has shown that teaching CBT in schools is trickier than it sounds.
To bring this into an Irish context; the Wellbeing curriculum — introduced in 2017 for students aged 12–15— indirectly endorses CBT principles to be taught in schools, in the context of teaching resilience and coping skills. The Department of Education and Skills is also training primary teachers in delivering the Friends for Life programme, an evidence-based programme to promote the wellbeing of primary school children through a CBT framework.
And that’s the key phrase to this issue: evidence-based. Teaching CBT skills to young people blurs the lines between education and a health intervention. There is a clear argument on the potential value of teaching CBT skills in the classroom, but its effectiveness rests on the proper delivery of the class to students.
At this point, some people might think, what’s the harm if it’s not evidence-based? Why not roll out CBT in classrooms across the country anyway, in the hope it might work? These are fair questions, but there are several issues to consider here.
The first one relates to the impression students will get of CBT from it being taught to them. If CBT were taught in schools badly, then it could turn some students away from seeking professional help when they may need it. Blindboy suggested that if he could teach CBT principles in his podcast, then anyone could, but that’s debatable. Blindboy is a highly skilled and experienced communicator with a dedicated audience. He has invested significant amounts of his own time into understanding CBT and other therapies. The average teacher will not have had the same background in understanding CBT and would require significant amounts of training to teach it to teenagers.
Delivering this type of class could add to the pressures on teachers too. There is no consensus yet among researchers if CBT classes should be delivered by teachers or by specialists coming into secondary schools. If they are to be delivered by specialists, this will require additional funding. If teachers are to deliver them, they would need to be trained carefully (as is being done at the moment with the Friends for Life programme), which requires funding and time. There also needs to be a foundation of evidence to build on, to secure that funding.
The complex nature of mixing health and education is also a key issue. Teaching CBT skills would involve taking what is currently a clinical intervention and adapting it to a non-clinical group. This should be grounded in research and evidence to make sure that it does as much good as it possibly can while ensuring that there are no adverse effects for the young people being taught. A half-baked attempt at teaching CBT without clear guidance and training for teachers on how to do it would not be good enough.
So, with that taken into account, what is the current evidence-base for teaching CBT in secondary schools? The truth is that it’s mixed.
One of the largest attempts at teaching CBT skills universally is the Penn Resiliency Programme. This has been tried through schools with teenagers in the US, Australia and the Netherlands. While the Penn website highlights the proud history of the programme with regards to being grounded in research, the latest review of results found that the programme didn’t improve mental health outcomes in secondary school students.
On the other hand, there is promising research happening in the area of mindsets and mental health. Mindset research — which highlights the importance of holding a growth mindset — is related to the idea of psychological flexibility that is central to CBT approaches (which Blindboy addressed in his podcast). Early research on mindset research and youth mental health is encouraging, with young people displaying fewer signs of low mood than a control group up to 9 months post-intervention. While more research needs to be completed in this area before a national rollout, there is significant potential for it to be piloted in Irish schools and to examine whether it is an effective approach for Irish students.
While Blindboy has argued for CBT skills to be taught in schools, this needs to be approached with patience and with caution. If school-based CBT is to have any impact on young people’s mental health, researchers generally agree that it would be a small effect at best. School-based mental health approaches are not like vaccines — we can’t wipe out mental illness just by teaching these skills to a class. They are a small part of a much larger puzzle surrounding youth mental health in general. Nevertheless, it is an avenue worth exploring, in the hope that it makes a positive contribution to young people’s mental health.
