Innovative health program reduces depression, unhealthy weights in teens

COPE program has positive effects that last at least a year after completion

Schools can significantly improve the long-term physical and mental health of teens by implementing cognitive behavioral skills-building into already existing high school health curriculums, according to a study funded by the National Institutes of Health/National Institute of Nursing Research and published in the December issues of the Journal of School Health.

The article reports that 12 months after completing the COPE Healthy Lifestyles TEEN Program, students had markedly lower body mass index than students who received a more standard health curriculum. Additionally, COPE teens who began the program with extremely elevated depression had symptoms in the normal range after 12 months.

COPE (Creating Opportunities for Personal Empowerment) Healthy Lifestyles TEEN (Thinking, Emotions, Exercise, Nutrition) teaches adolescents that how they think is directly related to how they feel and behave. It also teaches them how to turn negative beliefs triggered by “activating events” into positive beliefs so that they feel emotionally better and engage in healthy behaviors. The program is based on cognitive behavioral therapy (CBT), with an emphasis on skills-building.

The lead author of the article is COPE creator Bernadette Melnyk, PhD, RN, CPNP/PMHNP, FAANP, FNAP, FAAN, associate vice president for health promotion, chief wellness officer and dean of the College of Nursing at The Ohio State University. Melnyk is also a professor of pediatrics and psychiatry at Ohio State’s College of Medicine.

“CBT is the gold standard treatment for depression and anxiety, but it has traditionally been used in, one-on-one, hour long therapy sessions,” said Melnyk, who began developing the program more than 20 years ago as a pediatric and psychiatric nurse practitioner. “With COPE, I’ve created a tool that can be used by any health professional or educator so they can teach cognitive behavior skills to adolescents. This is huge for schools or community centers. We can really make positive impacts on teens’ lives by teaching these skills to them.”

This study was aimed at evaluating the long-term efficacy of COPE. A total of 779 high-school students aged 14 to 16 in the Southwestern United States participated in the study. Half attended a control class that covered standard health topics such as road safety, dental care and immunizations. The others were enrolled in the COPE Healthy Lifestyles TEEN program.

Health teachers were provided a full-day workshop on COPE and how to teach the program. The classroom curriculum blends cognitive-behavioral skills sessions with nutrition lessons and 20 minutes of physical activity, such as dancing, walking or kick-boxing movements.

The 12-month follow-up evaluation after the COPE program showed a significant decrease in the proportion of overweight and obese teens. Only 4.8 percent of COPE teens moved into the overweight category compared to 10 percent of the control group, Healthy Teens, who moved to either overweight or obese. None of the COPE teens  moved to the obese category.  Further, COPE teens who were on public assistance had a significant decline in body mass percentile following the intervention than teens on public assistance who were on public assistance.

A particularly important finding, Melnyk said, was that COPE students who began the study with severely elevated depressive symptoms had significantly lower depressive scores that fell into the normal range than the Healthy Teens students at 12 months post-intervention.

“Because the majority of adolescents with depression do not receive treatment, and even fewer receive CBT, it is vital that we provide them the tools and ability to engage in positive thinking and employ effective coping,” she said. “The feedback from the teens during the open-ended evaluations included hundreds of comments specifically indicating that the COPE program helped them deal effectively with stress and anger as well as to feel better about themselves.”

This latest article reflects a continuation of positive results from COPE.

In 2013, Melnyk published an article in the American Journal of Preventive Medicine, examining immediate and six-month outcomes of COPE. Those results showed increased physical activity; decreased BMI; higher grades, better scores in cooperation, assertion and academic competence – as rated by teachers; and lower alcohol use.

Melnyk said next steps should include implementation of COPE into health curricula across the country. Because a variety of professionals can learn the program, she hopes to see widespread use in schools, community centers and youth organizations to help teens lead healthier, happier lives and perform better academically.

The National Institutes of Health/National Institute of Nursing Research supported this research.

The article notes that overweight/obesity and mental health disorders are significant public health problems that threaten health outcomes and academic performance of U.S. teens. Approximately 17 percent of U.S. youth are obese and 15 percent are overweight, according to research cited by Melnyk.

Additionally, 15 million U.S. youth have a mental health problem that interferes with functioning at home or school, but fewer than 25 percent receive treatment, and even fewer receive CBT.