Mindstrong to Combat Bullying: An Intervention for Adolescents who have Experienced Bullying and Present to the Healthcare Setting

Abstract

<h3>Purpose</h3> The purpose of this study was to examine the feasibility, acceptability and preliminary outcomes of a Cognitive Behavioral Skills Building (CBSB) manualized program for 12-17 year old adolescents who experienced bullying and reported depressive and/or anxiety symptoms. <h3>Background</h3> One in five children report experiencing bullying. Bullying in childhood adversely affects the physical and emotional health and functioning of youth and has been shown to exacerbate depression, anxiety, somatic complaints, and suicidal ideation/behaviors. Schools are overwhelmingly tasked with addressing bullying; however, school-based bullying programs are often focused on prevention and do not provide services for individuals who have experienced bullying and suffer adverse health events. Nurse Practitioners often encounter these patients in their clinical practice, but have limited tools to treat these patients. <h3>Problem Statement</h3> There is a paucity of evidence-based interventions for adolescents who have experienced bullying and suffer from adverse mental and physical effects and none that address individuals who present to the healthcare setting. The primary aim of this study was to assess the feasibility and acceptability of the Mindstrong to Combat Bullying program with adolescents. The secondary aim was to evaluate the preliminary effects of the Mindstrong to Combat Bullying Program on bullying victimization, cognitive beliefs, somatic symptoms, depressive and anxiety symptoms, and self-concept. <h3>Theoretical Framework</h3> This study used Cognitive Theory (CT), as developed by Beck (1979), and Cognitive Behavioral Skills Building (Melnyk, 2007) as well as recent evidence from bullying interventions to guide the development of the intervention program. <h3>Methods</h3> The IRB approved study used a pre-experimental pre/post design. Participants were recruited from a pediatric hospital's psychiatric intake department. The Mindstrong program, adapted from the evidence based CBSB COPE program (Melnyk, Kelly & Lusk, 2013), was delivered in 7 weekly sessions. Standardized and valid measures were used for depression, anxiety, bullying victimization, cognitive beliefs and self-concept. Repeated measures ANOVA was used to evaluate the effects of the intervention on depressive, anxiety, and somatic symptoms, self-concept, personal beliefs, and bullying victimization across three time-points. <h3>Results</h3> Twenty adolescent and caregiver dyads enrolled in the Mindstrong to Combat Bullying program, and 15 dyads completed all intervention sessions. Significant reductions were found over time in adolescent self-reported depressive, anxiety and somatic symptoms as well as bullying victimization frequency, with large positive effect sizes for the intervention. Significant increases in adolescent personal beliefs were found. The program was found to be highly acceptable by the adolescents and caregivers as evidence by feedback on exit surveys. Feasibility of the intervention was challenging as many intervention sessions needed to be rescheduled and many of the adolescents did not complete their weekly homework. <h3>Conclusion</h3> Mindstrong to Combat Bullying was found to be a highly acceptable intervention for adolescents that was effective in reducing physical and mental health symptoms as well as perceptions of bullying victimization. In the future, it may be beneficial to move this intervention to an online format with some personal contact and create strategies to enhance adolescent engagement with the skills building activities.