A training program to support young people’s struggle with stress and burden

Whenever a child behaves aggressively at school, a lack of parenting is often assumed. This overlooks the possibility of underlying mental health problems. Through a new type of training program, researchers at the University of Basel are attempting to train young people to better cope with stress and strong emotions.

Aggressive behavior exhibited by children and adolescents can indicate mental illness, which can stem from a variety of underlying causes. Despite the unfavorable outcome of severely aggressive behavior, the research community has devoted little attention to the issue until now, even though aggression is becoming an increasingly common problem in schools and socio-educational facilities. With the "Start Now" program, researchers from the University of Basel and the University Psychiatric Clinics are rising to meet this challenge.

"Disruptive behavioral problems can manifest in various ways: For some, in extreme outbursts of anger with a lack of control over emotions, coupled with strong verbal and physical aggression. Others show more planned aggression or a lack of empathy. Difficulties complying with rules or even legal troubles can also be observed," explains Christina Stadler, Professor of Developmental Psychopathology at the University of Basel.

"Affected children and young people often interpret their environment differently, for example, by perceiving the intentions of others as hostile, possibly due to past negative experiences," Stadler says.

In a lot of cases, this leads to a cascade of unfavorable consequences. It is not uncommon for adolescents to concurrently suffer from depression, addictive behaviors or untreated ADHD. Over time, this is frequently compounded by dropping out of school or being placed in a youth welfare institution, posing a difficult situation not only for young people, but also for their parents and caregivers.

A specific training program

To provide affected young people and those around them with additional support, Stadler has developed a specific training program to enable young people to cope better with stress and strong emotions. "We want to motivate them to pursue their goals, even if they perceive their environment as hostile and don’t believe their efforts will get them anywhere."

"Imagine a typical situation that, we, as therapists, but also in the educational context, see again and again: while we may already have a goal in mind, the young person is not (yet) showing any motivation and simply does not want to change anything. Making a case using good arguments is usually just as ineffective as pointing out negative consequences."

The research group has now investigated whether the Start Now skills-training, implemented in various youth welfare institutions in Switzerland, Germany and the Netherlands, is effective in reducing aggressive and oppositional behavior in adolescent girls.

The international study involved 127 girls aged 12 to 20 years with a diagnosis of conduct disorder or oppositional defiant disorder who were placed in four socio-educational institutions. The facilities were randomly divided into two groups, one of which received standard care which has not always proven to be effective. The other received Start Now as an add-on intervention by trained social workers directly in their respective youth welfare institution.

Prior to the start of the 12-week program, the researchers conducted a psychiatric interview to assess diagnoses and number of oppositional and conduct disorder symptoms, and several questionnaires were filled out by girls, parents and social workers. The same measurements were taken immediately after the completion of the training and three months after the end of the treatment.

Immediately after treatment, no significant differences were identified between the two groups in the interviews, although the adolescent girls were judged as significantly less aggressive by social workers and less irritable by parents.

However, during the follow-up three months later, a significant reduction in symptoms was observed in the Start Now intervention group, indicating a delayed but clinically important treatment effect.

"We did expect to see a difference between the groups immediately after treatment," says Stadler. "However, we were able to show that girls who learned strategies for regulating emotions in the Start Now program continue to improve. In contrast, this was not observed among the participants who only received standard care. We assume that the girls further deepened the skills they acquired beyond the training period. But the effect could also be related to the fact that girls still received in-vivo coaching from the trained social workers, which is one of the core components of Start Now."

Based on the positive experience, Start Now is also being offered as a prevention program in schools. The research group is currently conducting another clinical study on the effectiveness of an adapted Start Now program for adolescents and young adults who experienced migration.

Start Now is a skills training program for young people aged 12 and over. It promotes resilience and helps them to cope with stress and strong emotions. The aim is to acquire effective skills to prevent them from losing sight of their own goals and values as they mature, in spite of emotional difficulties. The strategies taught by the program include self-efficacy, taking initiative, problem-solving, a positive evaluation style, and most importantly, good regulation of emotions and stress.

Originally developed in the US, the Start Now program has been tailored to the needs and interests of young people by Christina Stadler and her team. The program consists of group and individual sessions, each beginning with a comic depicting relatable problems. This makes it easier for young people to get into the subject matter. During each session, specific strategies are presented and practiced for "surfing the waves of life". The program also includes training for professional staff, with the aim of better understanding the causes of problematic behavior and being able to respond appropriately to them, as well as being able to carry out the group training themselves.