Should We Teach Cognitive Behavioral Therapy in Schools?

Celia Ortega / Unsplash

[Image description: colored photograph of a children's classroom, blurry background filled with coats, pictures, and books. A calendar and a full pencil holder sits in the clear foreground]

Prevention is the best cure for what ails you. We push this rhetoric when it comes to avoiding a nasty such as a nasty cold, conducting monthly breast exams, or getting vaccinated, but not when it comes to preventing mental illness.

According to the National Alliance on Mental Illness (NAMI) 20 percent of adolescents between 13 and 18 live with some sort of mental health issue, 11 percent with a mood disorder, and eight percent with an anxiety disorder. 50 percent of mental illness cases start by age 14, and 75 percent by 24. And as age goes on, the numbers only increase.
These statistics clearly show that the time to act is during adolescence, not after adulthood has begun. Especially since 90 percent of suicide cases come from those with a mental illness.

With this in mind, I questioned how these statistics would differ if we used cognitive behavioral therapy as a preventative measure, rather than just as a post-diagnosis treatment. Specifically, if we were to teach CBT in schools.

I’ve spent most of my life with various disorders. I’ve had obsessive-compulsive disorder (OCD) from before I can even remember, from bodily twitches to intrusive thoughts. I vaguely remember when my first rituals and compulsions began, but generally, it’s something I believe I was born with.

I started to develop depression towards the end of high school, an already turbulent time made worse by low frantic mood swings that terrified people around me. These mood swings continued into my university years, but now they had another friend to punish me with: anxiety. Panic attacks, dizziness, dissociation, you name it; I had it.

And I still do. I’m 27 now, so that’s around 20 years of discomfort I’ve had to live through. Despite this, I was only officially diagnosed around seven years ago.

My depression has settled comfortably since I finished Cognitive Behavioral Therapy (CBT) in 2012, and a round of SSRI medication. However not only is OCD not curable, but my anxiety has been incredibly stubborn and decided to stick around. My anxiety is a lot better than it once was, but many of the symptoms I hate most stuck to me like glue.

I’ve accepted that OCD is part of my neurology, but I thoroughly believe that if I had been taught about self-help as a child, then I may not have developed the other two disorders, or at least dealt with them as long for nearly as long.

My story is a very generic one, as there are tons of people out there who had to deal with adolescent depression and anxiety without treatment. You only have to look at the statistics to realize how common adolescent mental illness truly is, and just how badly we need to start helping the youth of today.

Why isn’t CBT already a part of the curriculum?

We know that CBT is an effective form of treatment for children and teens with mental health conditions. Therefore it should make sense that the earlier its techniques are utilized it, the more effective it becomes. Just like with learning a language or new skills, a child’s brain will more easily soak up self-help skills that adults often have trouble adapting to. Just like me and my anxiety.

I wanted to talk to those who had experience with childhood CBT, so I took to social media for some opinions. I chatted with Sylvia, freelance journalist from Oakland, CA, about her experience with childhood CBT sessions. She writes,

“At a very young age, my parents began to notice certain things about me that I thought were normal.” She told me. “I was prone to bouts of anger followed by numb silences, more so than the average child. They were very progressive loving people, so instead of blaming me or dubbing me a problem child, they took me to a child psychiatrist for some advice. As my sessions advanced, I became a lot less volatile and I remember feeling a lot happier. I was being bullied pretty heavily back then, so I think if I hadn’t gotten the help I needed I would have lashed out at loved ones the way I wish I could have lashed out at the bullies.”

Sylvia’s experience goes to show that diagnosing and treating mental health issues early is vital in ensuring recovery. Her happiness increased, her behavior became more stable; don’t all children deserve this?

Teaching CBT in elementary schools will ensure that children will have the skills needed to take care of their mental health before a disorder(s) even develops. This would mean that a) the risk of depression and anxiety may decrease, or b) they will know how to deal with a disorder better that decides to stick around.

The reason why I know this, on top of common sense, is because certain schools and researchers have already tested the theory. The Preventing Anxiety in Children through Education in Schools project (otherwise known as PACES) was carried out by Oxford University in 2014. 1362 children aged 9-10, from 40 different schools, were given either classroom-led CBT by teachers, or mental facility based CBT for an entire year. The results showed that not only did it help children manage their emotions and stress levels, but also their problem-solving skills.

This wasn’t the only time this kind of thing has shown progress.

The older generations tend to forget that behavioral change only occurs with rehabilitation, and that harsh punishment can often make the child act out instead of change. Robert W. Coleman Elementary school in Baltimore has taken the idea of prevention and self-help to a new level. Instead of detention as we know it, the school instead now holds meditation sessions. 

"I did some deep breathing, had a little snack, and I got myself together," one of the pupils told CNN. "Then I apologized to my class."

The principle of Robert W. Coleman Elementary has stated that there has been a dramatic decrease in students getting referrals and suspensions after the meditation sessions began. This shows that deep breathing, positive thinking, and other meditative activities also present in CBT, really affect behavior. 

And in a country where mental illness is often blamed for constant school shootings, this can only help change the tides. Whether it helps students with behavioral problems to drop their guns, or finally show the government that it is not a mental illness that causes these tragedies, but a combination of white supremacy and toxic masculinity. Incidentally, these are also things that preventative therapies can help heal.

Stigma is partially to blame

A main factor influencing why disorders such as depression and anxiety are difficult to prevent (aside from chemical imbalances and life changing events) is stigma. The lack of awareness and in-depth knowledge of mental health is also to blame. In terms of the Oxford University study, one of the reasons why classroom-led CBT was not as effective as the psychologist-led class, may have due to the prevalence and lack of awareness in non-psychology trained teachers. It may also be due to the fact that therapy given in a professional medical session is usually always more effective than anywhere else. This doesn’t mean that classroom-based CBT is poor. It just means that classroom-based CBT cannot solely replace medical treatment. 

Spectator / Google

[Image Description: A Google screenshot from spectator.org reading: Generation Snowflake: how we train our kids to be censorious cry … If today's students believe that hearing a dissenting opinion can kill them, it's because we taught them to think like that .... The Higher Education Funding Council for England has estimated that the number of students declaring that they suffer from a mental health problem .... Oh look....a special snowflake^.]

This kind of stigma and lack of awareness is one of the leading factors in why schools don’t already have compulsive CBT classes. One very common argument against mental health treatment is an unfounded belief in hypochondria. “It’s all in your head!” say neurotypical people who haven't experienced these illnesses “There’s nothing wrong with you, you just need more exercise!” is another one. And of course, "You’re just attention-seeking, stop being negative!” is bandied about as well. The idea of teaching anything mental health related in public education, to those who don’t believe mental illness is real, terrifies people. They think it’ll turn the next generation into “special snowflakes" who just want coddled.

I'm not saying kindergarten kids should be given extensive psychology training, but basic self-help skills such as The Five Areas taught during guidance class would do wonders for their futures as well as their childhood experiences.

Five Areas / DSN.org

[Image Description: A Chart showing the Five Areas. Altered thinking -> altered physical symptoms -> altered behavior -> altered feelings]

When I was in high school, there was a compulsory guidance class every week; one hour a week to learn about how not to do drugs, why you shouldn’t start fires, and how to dial 911. It was all very useful information, but each class felt very empty. We were usually shown an old out of date PSA video, given a short quiz on the topic, and then told to use the remainder of the class to study other subjects. Not to say personal study isn’t important, because not everyone has time to do all the work they need to do after class. But ultimately, the class felt like filler until the bell rang. Many of the topics we learned about were very similar. One class we watched a video on what happens when you sniff glue. Then the next video was almost identical in its information but with breathing in aerosol fumes. That was one class stretched into two, for no discernable reason.

Surely there was enough room in that very loose curriculum to do some work on mental health skills? But I never saw it. We did have anti-bullying classes. but the curriculum mostly consisted of what to do if you become a victim. Which was always “tell an adult and don’t fight back,” and never “here’s how to work past the trauma that bullying can cause.” I can understand that the public school system is already underfunded and, and the budget for each school differs greatly, but I think most parents and children would agree that they’d like to learn about how to help themselves. Especially when they need it most. 

Worldwide healthcare systems would also benefit. According to the London School of Economics, investing in early prevention services for mental health could save the British National Health Service over 14 million pounds per year. The report shows that 54% of psychosis funds are going to inpatient care, as opposed to community preventive services. This logic could easily be applied to U.S. healthcare, or anywhere in the world for that matter.

Another Set of Skills The School System Denies Students

A common critique amongst school graduates is how the curriculum doesn't set the student up for the working world with practical real-life skills. Skills such as not knowing how to balance a checkbook, preparing a tax return, or what the hell mortgages are all about. We millennials were never taught any of this. I’d like to add mental health awareness to this list.

I’m not the only one who feels this way, as made obvious by the research done into the subject, but also according to interviews that I conducted myself. I spoke with Stephy, an admin professional, about her thoughts on the issue:

“Having been born with ADHD, it was pretty much a given that I was going to develop anxiety and/or depression,” she told me. “Most people don't have just one of the three. But being taught some coping skills would have made my teenage years a lot less stressful and painful.”

Taking away some stress and pain from an incurable disorder is vital to making sure the patient stays safe. Often being diagnosed with a mental illness is a terrifying ordeal that many people find difficult to deal with. Myself included. If the school system can help decrease those fears and stigma about seeking help, then recovering or treating the disorder will be just a little easier to deal with. 

We need to share the responsibility

Critics say it’s not a school's job to teach this type of curriculum, that it’s up to the parents. Yet if the child doesn’t have a safe support system at home, or if they are carers for their own parents, then where else can they turn?

It’s understandable that teachers may be wary of essentially becoming doctors to their pupils. Guardian writer Natasha Devon says it well when she wrote:

“When it comes to mental health, schools can do only so much. While teachers can be incredibly effective at prevention and spotting early symptoms, they cannot be doctors. And they cannot refer their pupils for the medical support they need if that support does not exist.”

The mental health of the teachers and their ability to help the students is, of course, important. However, this is why the school system as a whole needs to step in, rather than just the individual teachers themselves.

Teaching is and always will be the main focus in education. If the previous generation were not taught a skill, then how are they going to teach their children? Critics also assume that every parent can afford to get their child help in the first place too. Even though during 2016 alone there were 40.6 million people in poverty. And that’s just the United States.

Another argument against teaching CBT in schools is that it will take away time from “more important” classes such as mathematics or the sciences. Yet I believe it can be easily spliced into the already existing guidance module. Nothing needs to be taken away, simply compartmentalized. The key to knowing how CBT will work in specific schools is to introduce it slowly. It doesn’t have to replace history class or take hours away from anti-drug lectures. It can be given as homework, introduced into English class alongside literature about mental health, taught for a short number of weeks in guidance class, or merged with solo study classes. The possibilities are endless.

It's also within the school's best interest funding wise to keep their students healthy. 37 percent of age 14 students with mental health conditions go on to drop out of school. This, in turn, may affect their ability to afford a place to stay. Dropouts mean less school funding, and this means a lower quality of education for future students. So why are schools so against the idea of teaching CBT if it’ll help keep money in their pockets?

Dropouts also lead to an increased chance of homelessness, not to mention that mental illness can lead to increased chances of homelessness too. So there are plenty of pitfalls to not teaching CBT in schools, not just benefits.

CBT classes would also benefit children that one day would like to go into psychology. The course curriculum wouldn’t be more exhaustively comprehensive than a pre-teen would understand, but the basics are vital for further learning. Additionally, CBT generally helps develop empathy and understanding. If would-be bullies learn about what their potential bullying could cause, it may stop them from becoming one in the first place. Since bullies can also experience abuse at home, they perpetuate and project those feelings on other children at school. Thus ending the vicious cycle of torment.

Caleb Woods / Unsplash

[Image description: A long-haired child in white stands sadly with her face in her hands, against a jet black background]

Let’s Give Future Generations a Chance

If I had known about the thought exercises that come with cognitive behavioral therapy, then I would have been able to challenge those negative thoughts before they overtook me. This is, of course, not the same for everyone; especially for those who have severe chemical imbalances. However, my recovery was all down to re-coding my thoughts, and letting the medication do all of the technical stuff. I worked hard in therapy to get to where I am now, mood wise especially.

But I can’t help but think if I’d seen CBT material beforehand, I wouldn’t have hit rock bottom as hard as I did, I would have been using those thought processes already to prevent the mood swings. My OCD wouldn’t have been this terrifying monster that I couldn’t tell anyone about, it would just be part of my personality that needed extra care. I know this now, but it would have helped to know it back then.

My adolescence as a whole would have been less frightening, I just know it.

Teaching children how they can prevent symptoms, teaching teenagers how to treat existing symptoms will pave the way for healthier and happier adults. We’ve already seen it work, so let’s see it in every school.

If you would benefit from free CBT materials then check out FiveAreas, Therapist Aid, and even Pinterest for some worksheets and further information.

---

Stephanie Watson is a feminist  writer, editor, and zinester, who specializes in pop culture, and psychology. She is the EIC of Fembot Magazine, and a contributor to YourTango, New Normative, HelloGiggles, and many more.