Table 1.

Overview of interventions based in primary and secondary schools

Study (location)	Sample	Study aim/hypothesis	Intervention – theoretical model and content	Intervention – setting, structure and delivery
Primary schools
Attwood et al 30 (Bristol, England)	Boys aged 10–12 years from two coeducational schools (n=13).	A proof of concept study to explore the viability and possible benefits of a computerised CBT (cCBT) programme.	‘Think, Feel, Do’ – based on CBT principles with a psychoeducation component. Cartoon characters guide users through various activities including: emotional recognition; linking thoughts, feelings and behaviours; identifying and challenging negative thoughts; and problem solving. Involves quizzes, practical exercises, videos, music and animation.	Six x 45 min sessions delivered via an interactive multimedia CD-ROM. Took place within the school and facilitated by the researcher.
Berry et al 31 (Birmingham, England)	Pupils aged 4–6 years (n=5075; 56 x schools).	Test the effectiveness and cost-effectiveness of the intervention to reduce children’s level of behavioural and emotional difficulty.	’Promoting Alternative Thinking Strategies' aims to improve skills in five areas: self-awareness, managing feelings, motivation, empathy and social skills. Lessons are developmentally sequenced and focus on techniques for self-control; emotional and interpersonal understanding steps for solving interpersonal problems; positive self-esteem; and improved peer relationships.	44 lessons in year 1; 47 lessons in year 2. Delivered by trained teachers within classroom. Manual provides teacher scripts, pictures, activity sheets, photos, posters and home activities.
Collins et al 32 (South Lanarkshire, Scotland)	Pupils aged 9–10 years (n=317; 9 schools; 18 classes).	To explore if anxiety and coping showed improvement postintervention, and test effects of delivery.	‘Lessons for living: Think Well, Do Well’. CBT-based intervention to develop coping skills. A series of skills practice using interactive teaching methods. Children are guided to recognise emotional symptoms, reduce avoidant coping strategies and focus on proactive problems solving and support-seeking.	Ten lessons delivered by a psychologist (n=103) and teacher (n=79) during PHSE. Teachers provided with intervention manual following 1 day training.
Stallard et al 33 (Bath and North East Somerset, England)	Pupils aged 9–10 years (n=106; three schools; four classes).	To evaluate an Australian-originated intervention in the UK; test delivery by school nurses.	’Feelings, Relax, I can do it, Explore solutions, Now reward, Don’t forget practice, Smile’ (FRIENDS). Based on CBT principles, it teaches children practice skills to: identify their anxious feelings and learn to relax; identify unhelpful thoughts and replace them with helpful thoughts; face and overcome problems and challenges.	Ten sessions delivered by school nurses who attended 2-day training. Lessons comprise group work, workbooks, role play and games. Parents invited to preintervention session.
Stallard et al 34 (Bath, North East Somerset, Swindon, Wiltshire, England)	Pupils aged 9–10 years (n=1448; 45 × schools).	To assess the effectiveness of FRIENDS delivered by both health and school professionals on anxiety prevention.	As above.33	Nine × 60 min lessons delivered to whole classes. Health-led group: two trained facilitators. Teacher-led group: led by class teacher. All attended 2-day training.
Secondary schools
Boniwell et al 35 (South East London, England)	Pupils aged 11–12 years (n=296; 2 × Haber-dashers’ Aske’s Fed. of Schools)	To test the efficacy of a new school programme for the promotion of happiness and well-being skills.	‘Personal Wellbeing Lesson Curriculum’. Covers the ‘scientific basis of happiness’ focusing specifically on two core aspects: positive emotions/experiences and positive relationships. Based on theoretical constructs from well-being research and positive psychology for example, ‘three good things’, forgiveness letter and gratitude visit.	Eighteen biweekly 50 min scripted lessons delivered to eight classes by four teachers who attended a 5- day training. Provided with lesson plans, PowerPoints and handouts.
Challen et al 36 (Greater London, North West England and North East England)	Pupils aged 11–12 years (n=2844; 16 × schools)	To evaluate a UK version of Penn Resiliency Program. Hypothesised high completion rates and reduction of depression symptoms.	‘UK Resiliency Program’. Aims to build resilience and promote realistic thinking and adaptive coping based on Ellis’s ‘Activating event-belief consequences model’. Teaches cognitive behavioural and social problem-solving skills; encourages accurate appraisal of situations; and assertiveness, negotiation and relaxation skills.	An 18-hour programme delivered within the timetable at the teacher’s discretion. Delivered by school staff who attended a 10-day training in the USA.
Chisholm et al 37 (Birmingham, England)	Pupils aged 12–13 years (n=769; 6 × schools).	To test whether contact with an individual with Mental Health (MH) diagnosis plus education is more effective in reducing stigma, improving MH literacy and promoting well-being than education alone.	‘Schoolspace’. A 10-module MH intervention designed by study researchers covering topics such as stress, depression, psychosis, different ways of thinking and a drama workshop. The ‘contact’ group had an individual facilitating who was an MH service user and had a diagnosis (eg, psychosis and Bipolar Disorder); this was revealed halfway through the day.	A 1-day intervention within the school led by National Health Service staff, trained volunteers and MH service users.
Kuyken et al 38 (England)	Pupils aged 12–16 years (n=522; 12 × schools).	To investigate the acceptability of a mindfulness programme for teachers and students; test efficacy of programme on MH and well-being.	‘Mindfulness in Schools Program’ (MiSP). Involved learning to direct attention to immediate experience with open-minded curiosity and acceptance. Skills were learnt through practice sessions and everyday application. Mindfulness practice used to work with mental states and everyday stressors to cultivate well-being and promote mental health.	Nine weekly scripted lessons delivered as part of the curriculum, or at lunchtime by seven teachers trained and approved to deliver the MiSP curriculum.
Rice et al 39 (South East England)	Pupils aged 13–14 years (n=256; 3 × schools).	To compare three types of intervention that may prevent adolescent depression and explore cognitive mechanisms involved with each.	’Thinking about Reward in Young People' (TRY) aimed to enhance reward processing through actively selecting activities to lift mood. CBT aimed to change negative thinking patterns by encouraging evaluation of thoughts. Mindfulness Based Cognitive Therapy aimed to promote awareness and acceptance of thoughts and to develop regulation of attention through guided meditation. Psychoeducation regarding depression was provided to all groups.	Eight weekly manualised sessions of each intervention delivered within 50  min PHSE lessons by educational psychologists who attended regular supervision.
Naylor et al 40 (Greater London, England)	Pupils aged 14–15 years (n=416; 2 × schools).	To explore whether teaching adolescents about mental health would result in gains in knowledge and empathy.	Mental health lessons. Topics included: stress, learning disability, depression, suicide/self harm, eating disorders and bullying using methods such as discussion, role playing and internet searching.	Six x 50  min weekly lessons delivered by seven group tutors from pastoral care who attended a 1-  day training from researchers.
Stallard et al 41 (Bath, North East Somerset, Bristol, Wiltshire, Nottinghamshire, England)	Pupils aged 12–16 years (n=5030; 8 × schools, 28 × year groups).	To assess effects of classroom-based CBT on symptoms of depression and in relation to other aspects of psychological well-being and specific demographic subgroups.	‘RAP-UK: Resourceful Adolescent Programme’. A depression prevention programme based on CBT and interpersonal therapy principles adapted to fit the UK curriculum. Key elements include: personal strengths, helpful thinking, keeping calm, problem solving, support networks and keeping the peace. Students complete workbooks as they progress.	Nine x 50–60  min manualised lessons delivered within the PHSE curriculum by two trained facilitators external to the school. Two booster sessions offered to schools at 6-month follow-up.

CBT, cognitive behavioural therapy; PHSE, Personal Health and Social Education.