Development of Curriculum for Instruction of Practices That Promote Positive Mental Health in High School Students Following the COVID-19 Pandemic by Kelly Pinkston A project submitted in partial fulfillment of the requirements for the degree of MASTER OF EDUCATION with an emphasis in CURRICULUM & INSTRUCTION WEBER STATE UNIVERSITY Ogden, Utah August 8, 2023 Approved Daniel Pyle, Ph.D. Shernavaz Vakil, Ed.D Stephanie Speicher, Ph.D. 2 Acknowledgements I would like to thank the excellent professors at Weber State University for sharing their time, insights, and passion for learning. They are a talented group of educators who care about their students and helping them to reach their best potential. A special thanks to my committee chair Daniel Pyle for your encouragement and wisdom as I completed this project. Thank you to committee members Stephanie Speicher and Shernavaz Vakil. Professor Speicher, I appreciate you opening my eyes to possibilities available through the Digital District and suggesting improvements with my Canvas content. Professor Vakil, I appreciate your insight into making the content work within the structure of a secondary classroom. Thank you to Bryon and Parker for your patience, love, and support. You have been there for me when I needed a sounding board, an understanding ear, or a target student. Thank you to Davis School District and the wonderful supportive staff at Davis High School. Lastly, thank you to Vista Education Campus, where I fell in love with teaching. 3 Table of Contents Introduction..................................................................................................................................4 Literature Review.........................................................................................................................5 Depression and Anxiety among Adolescents.......................................................................... 6 Increasing Well-being.............................................................................................................. 7 Cognitive Behavior Therapy.................................................................................................... 9 Growth Mindset......................................................................................................................10 Resilience...............................................................................................................................11 Self-care................................................................................................................................ 13 Physical............................................................................................................................13 Emotional......................................................................................................................... 16 Social Connection............................................................................................................ 19 Purpose...................................................................................................................................... 21 Methods...................................................................................................................................... 22 Context.................................................................................................................................. 22 Scope.....................................................................................................................................22 Evaluation.............................................................................................................................. 23 Procedures............................................................................................................................ 23 Results........................................................................................................................................25 Learning Outcomes............................................................................................................... 25 Accessibility........................................................................................................................... 25 Module Topics........................................................................................................................26 Potential for Impact................................................................................................................27 Discussion..................................................................................................................................27 Implications............................................................................................................................27 Recommendations.................................................................................................................29 Limitations..............................................................................................................................29 Conclusion................................................................................................................................. 30 References................................................................................................................................. 32 Appendix A.................................................................................................................................52 Appendix B.................................................................................................................................59 Appendix C.................................................................................................................................60 Appendix D.................................................................................................................................74 Appendix E................................................................................................................................. 78 Appendix F................................................................................................................................. 79 Appendix G.................................................................................................................................80 Appendix H.................................................................................................................................82 4 Development of curriculum for instruction of practices that promote positive mental health in high school students following the COVID-19 pandemic The disruption of daily routines during the worldwide COVID-19 pandemic caused negative effects on the emotional well-being of adolescents. Several factors compounded the emotional distress experienced by teenagers as their lives were turned upside-down. Among those factors, adolescents had concerns over their own health and that of family members. Adolescents also had to adjust to changes in their routines due to school closures (Gur-Arie, 2022; Kavacs et al., 2021; Viner et al., 2020; Viner et al., 2022). Families faced food supply chain shortages as prices increased, buying limits were imposed, and grocery store shelves sat empty (de Paulo Farias & Dos Santos Gomes, 2020; Nagata et al., 2021). Family finances were put under strain as many in the workforce found themselves unable to work (Hammen et al., 2008; Schleider et al., 2022). Teens were isolated away from friends and other social interactions due to stay at home orders and the general fear associated with illness (Barendse et al., 2021; McMahon, 2022; Whiteford et al., 2013). Without interventions to support teens, they are at a higher risk of suffering from anxiety and depression. Concerning impacts of depression and anxiety, teenagers are already a vulnerable group (Schleider et al., 2022). In the wake of the COVID-19 pandemic this vulnerable group exhibited higher rates of depression and anxiety than had previously been observed (Chen et al., 2020; Racine et al., 2021). In addition to depression, Ma et al. (2021) found an increase in Post-Traumatic Stress Disorder (PTSD). Adolescents need interventions and supports to guide them through the effects of the disruptions and emotional distress experienced during the COVID-19 pandemic. 5 One potential solution is to offer an in-school curriculum to students that instructs and supports applied experience in specific practices which will help them to increase their feelings of well-being. Previous research found that participants with short-term exposure to explicit instruction experienced the benefits of reduced feelings of hopelessness, depression, and anxiety (Schleider et al., 2022). Participants also reported an increase in positive feelings including perceived agency. Guided practice focusing on mindfulness exercises showed an increase in feelings of resilience, mindfulness, and group sessions fostered a feeling of connection with others (Cunningham et al., 2021; Flett et al., 2019; McMahon et al., 2022; Zollars et al., 2019). Mindfulness exercises decreased feelings of depression, anxiety, and stress. Stay home orders and the suspension of sporting activities lead to an interruption in routines pertaining to physical activity. Adolescents forced to forgo their usual activities, experienced an increase in weight gain, unhealthy physical habits, and a decrease in well-being (Ray et al., 2022). Adolescents could benefit from a structured curriculum that focuses on healthy habits that were inaccessible during the pandemic which may continue to impact students’ mental health. Literature Review The implications of the COVID-19 pandemic include disruption of daily routines of adolescents and their families. During the COVID-19 pandemic they were faced with the challenges of dealing with grief related to illness and death, quarantining in homes, and isolation from friends and family, all leading to a reduced feeling of well-being (Kim et al., 2022; Imran et al., 2020). Suspension of sporting activities led to an interruption in routines that facilitated physical activity. Adolescents forced to forgo physical activities, experienced an increase in weight gain and unhealthy habits (Ray et al., 2022). Ma et al. (2021) found an increase in PTSD among children between seven and 15 years of age. The effects of depression and PTSD were 6 intensified in older students and those in boarding schools. This disruption in routines and increase in unhealthy habits led to decreased feelings of well-being in the wake of the COVID-19 pandemic. Depression and Anxiety among Adolescents Vigo et al. (2016) projected that by 2030 mental illness will be the largest contributor to disease. Adolescents are in a particularly vulnerable position due to their transitional period and time of great sensitivity with rapid development of socialization, emotions, and cognition (McMakin & Alfano, 2015; Patton et al., 2016; Thapar et al., 2022). The prevalence of depression has increased drastically with young adults and adolescents over the past decade (Blakemore, 2019; Collishaw, 2015; Lu, 2019; Newlove-Delgado et al., 2021). Between 2011 and 2016 depression increased in 12 to 17-year-olds from 8.3% to 12.9% (Lu, 2019). In 2021 a meta-analysis of 29 studies, representing 80,879 participants from around the world focused on the prevalence of anxiety and depression in youth and found that depression was evidenced in 25.2% of youth with anxiety in 20.5% (Racine et al.). This incidence of anxiety and depression among children and adolescents represents a doubling since the onset of the COVID-19 pandemic. Chen et al. (2020) found similar results, among the 13 to 15- year-old population during the first few months of the pandemic with 21% of participants exhibiting depression and 23.5% anxiety. Depression has been trending upward over the last decade with the COVID-19 pandemic causing a significant increase in prevalence. When youth suffer from depression, they are at an increased risk of developing other psychological conditions. For example, depression is associated with the onset of anxiety (Costello & Maughan, 2015; McLeod et al., 2016), bipolar affective disorder (Uchida et al., 2015), eating disorders (Puccio et al., 2016), and suicide attempts (Johnson et al., 2018). 7 Furthermore, individuals with depression are also more likely to engage in drug and alcohol use (Groenman et al., 2017; McCrone et al., 2005) and participate in high-risk sexual behaviors (Foley et al., 2019; Lehrer et al., 2006). Thus, the presence of depressive symptoms is strongly correlated to increased risk of negative psychological outcomes. Depression in adolescents can also affect their physical health. Those with depression have an increased risk of obesity and cardiovascular disease (Goldstein & Korczak, 2020; Mannan et al., 2016). Depression in adolescents has been linked to the individual’s inability to find success later in life especially with interpersonal relationships (Allen et al., 2014; Giaconia et al., 2001; Kessler & Bromet, 2013). Education and work achievement are negatively affected by depressive symptoms (Clayborne et al., 2019; Johnson et al., 2018; Schubert et al., 2017; Weavers et al., 2021; Wickersham et al., 2021; Wickrama et al., 2009). The physical well-being of the depressive individual is negatively impacted but the good news is that measures helping to prevent occurrence of depression in teens lead to better adult functioning (Brent et al., 2015). Increasing Well-being In general terms well-being can be defined as the presence of positive physical, mental, and emotional attributes in life and the general absence of negative attributes. The result is not only the lack of mental illness but an overall feeling of satisfaction and fulfillment in life (Satici, 2016; Yaden et al., 2021). Those who have high levels of well-being feel optimistic about their life and believe that the future holds more good events than bad (Trudel-Fitzgerald et al., 2014). Measurements of well-being can be classified into two separate theoretical approaches: eudaimonic and hedonic well-being (Boehm & Kubzansky, 2012; Ryff & Keyes, 1995). Eudaimonic well-being focuses on a life full of meaning and purpose. The individual’s eudaimonic well-being increases when they have purpose in life, growth, self-acceptance, 8 mastery, and autonomy. Hedonic well-being is measured through the individual’s perceptions of their own happiness, satisfaction in life, and optimism (Boehm & Kubzansky, 2012). Though theorists sometimes make the distinction between eudaimonic and hedonic well-being, the constructs are similar with overlapping elements. Combining the two approaches leads to a well-rounded approach to improving physical, mental, and emotional perceptions of well-being. One’s sense of well-being is not fixed but can be cultivated and improved through deliberate training (Dahl et al., 2020). This is evidenced in a study on the effectiveness of a well-being course offered by Yale University. In an effort to reach a larger audience, Yale University published an online course called The Science of Well-Being (SoWB) that teaches learners the practices that lead to improved feelings of well-being. Yaden et al. (2021) studied the effectiveness of SoWB and found the course increased “positive emotions, engagement, relationships, meaning, and accomplishment” (p.3) as measured using the PERMA Profiler. PERMA is an assessment that measures the five pillars of well-being: Positive emotions, Engagement, Relationships, Meaning, and Accomplishment. Yaden et al. (2021), had the participants complete self-paced online courses where the control groups were instructed in general psychology and the experimental groups learned research specific to improving well-being. Additionally, as part of the course, the experimental groups were assigned the task of putting the positive interventions into practice in their personal lives. The control groups and the experimental groups had similar levels of well-being at the baseline measurement. Over three samples (N=2,250), Yaden et al. found that both experimental and control groups improved in feelings of well-being but the effects of the focus on well-being resulted in scores of self-reported well-being at 7.73, 7.69, and 7.80 compared to that of the control group of 7.33, 7.15, and 7.33. This is statistically significant with a p value < 0.01. The limitations of the study 9 include the high levels of attrition that can be expected with an online course (Yaden et al., 2021). Yale has now expanded their online course offering to include a course specifically for adolescents called "The Science of Well-Being for Teens” (Santos, n.d.). The instructional videos are available on Dr Laurie Santos’s YouTube channel and were used throughout the development of this curriculum project. Incorporating this valuable and research validated approach on the science of well-being, within an elective course offered to students in a general education setting, could provide the structure and content needed to create lasting benefits to overall well-being. Cognitive Behavior Therapy While working with patients in the 1960s and 1970s, a psychiatrist, Aaron Beck, noticed that many patients were held back from making improvements by what he termed distortions in their perceptions (Beck & Fleming, 2021). Individuals who suffered from depression and other mental health issues tended to dwell on negative thoughts and foster maladaptive beliefs about themselves and those with whom they interact. This realization led to Dr. Beck’s development of Cognitive Behavior Therapy (CBT). CBT is used to assist people in learning to identify their negative thought patterns or distortions and combat them with positive or more realistic perceptions surrounding an event or condition (Rohde, 2015). CBT is well-researched with over 2,000 studies showing its effectiveness in the prevention and treatment of a variety of psychological disorders including depression, stress, and anxiety (Beck & Fleming, 2021; Hofmann et al., 2012, Rohde, 2015). CBT has been shown to be one of the most effective methods for treating depression in adolescents (David-Ferdon & Kaslow, 2008). With the rising prevalence of depression in youth, Keles and Idsoe (2018) conducted a meta-analysis to study the efficacy of CBT administered to adolescents in a group setting as a means of delivering fiscally conservative treatment. 10 Twenty-three studies, incorporating 5,469 participants, were included in this quantitative analysis. The meta-analysis found a small but significant effect size in lowering depressive symptoms of participants post treatment and at follow-up (Keles & Idsoe, 2018). This research shows the benefits of CBT instruction in a group setting. Many teachers in the K-12 setting have taken on the burden of trying to support student’s social-emotional needs but they lack the training and time to properly instruct students in CBT interventions. Explicit instruction and practice with CBT in the general education setting would require the expertise of a licensed clinician. A curriculum that draws from elements of the framework of CBT has the potential to help students learn practices that will help to increase well-being. Growth Mindset Growth mindset, developed by Carol Dweck, theorizes that a student’s perceptions about intelligence will affect their motivation and achievement (Blackwell et al., 2007). Students with a growth mindset believe that intelligence is not determined at birth and can be influenced by effort. The opposite of a growth mindset is a fixed mindset where students believe their potential has a set limit. Students with a fixed mindset feel helpless to improve their situation and may attribute positive experiences to luck. Studies show a growth mindset can be cultivated, leading to students increasing in academic test scores over a two-year follow-up (Blackwell et al., 2007). Research conducted by Mrazek et al. (2018) found that instruction in growth mindset of self-regulation strategies led to an increase in persistence, decrease in effort avoidance, and an increase in behavioral self-regulation. The power of engaging students in the concept of a growth mindset is evidenced in research conducted by Schleider et al. (2022). The study provided youth with two half hour sessions focused on growth mindset of personality and engagement of meaningful activities. The 11 participants responded to a survey directly after the course completion and at a three-month follow-up. In both instances the participants indicated that they felt the sessions were valuable to them. Specifically, the participants remarked on a reduction in feelings of hopelessness, depression, anxiety, and increased feelings of perceived agency. With two brief interventions the participants gained lasting benefits to their mental health (Schleider et al., 2022). A fixed mindset can lead to maladaptive concepts or rigid beliefs of self, making the individual more likely to have mental and physical issues, such as depression and anxiety (Cowan et al., 2019; Evans et al., 2005). Individuals who are compassionate, accepting, and possess a growth mindset were found to have lower levels of depression, lower anxiety, and higher feelings of well-being (Barnard & Curry, 2011; Muris et al., 2016; Ortiz et al., 2019). Resilience Resilience is the emotional and mental flexibility to successfully adapt when presented with challenges in life (American Psychological Association, n.d.). A person with a high level of resilience is able to “bounce-back” from a crisis using positive coping mechanisms to adjust to the change. Individuals are confronted with stressor events each day. Some stressors can be easily managed using existing protective factors, meaning the individual’s acquired internal and external resources (Fletcher & Sarkar, 2013). When the protective factors are not enough to manage the stressor event, the individual is in disequilibrium, and they must use their resources to attempt to reintegrate into a state of homoeostasis. The extent of their resources, and how they use them, results in either maladaptation, adaptation back to homeostasis, or adaptations with growth above and beyond homeostasis. Maladaptive practices can lead to mental health issues, including depression and anxiety, making resiliency skills a protective resource and crucial component of preventative mental health care (Waugh & Koster, 2015). 12 While maladaptive practices are detrimental to well-being, having resilient protective factors is linked with better mental health even in people who have a history full of adversity and challenges (Fletcher & Sarkar, 2013). Brunwasser et al. (2009) conducted a meta-analysis of a course developed to promote resiliency called the Penn Resiliency Program (PRP). The meta-analysis included 17 controlled studies, with 2,498 participants. The focus was determining the efficacy of PRP in treating depressive symptoms in youth, delivered in a group setting. The program teaches strategies to “Enhance cognitive and emotional well-being, cultivate strengths of character, and build strong relationships” (Seligman, 2018). The meta-analysis showed that post intervention and at 12-month follow-up the treatment group reported lower levels of depression compared to the control group who received no intervention (Brunwasser et al., 2009). A similar meta-analysis by Ma et al. (2020) studied a broader range of resilience programs for youth in a variety of settings. The analysis encompassed 24,135 participants in 38 controlled studies. The results suggested significant effect sizes in both post treatment and six-month follow-up. The most significant effect size was found in programs that were led by a professional interventionist, were administered to a targeted sample, administered homework, and were based on the PRP. A professional interventionist and targeted samples may not always be cost-effective or feasible in a school setting, therefore it is important to note the study determined a universal delivery with school personnel also delivered significant effect size post treatment (Ma et al., 2020). The findings of Ma et al., 2020 support the efficacy of delivering curriculum focused on well-being in secondary schools. A study in the United Kingdom of a program called the Hummingbird Project, showed a comparatively large effect size (resiliency 0.12, hope for the future 0.24) post teaching resiliency-based lessons in schools (Platt et al., 2020). The post treatment assessments showed 13 participants increased in measures of well-being, grit, tenacity, and hope. The program was administered in the regular classroom setting where a researcher and psychology students taught six, one-hour sessions. Platt et al. proposed that there is an opportunity to refine the program into a system that a general education teacher can be easily trained to facilitate, “Having an intervention that is easily delivered by staff with minimal training has the potential to have a positive effect on staff well-being as well as improve student mental health” (Platt et al., 2020, p. 6). Refining of the content and implementation has the potential to overcome the previously evidenced deficit in effect size when materials are administered without a professional interventionist while adding benefit to staff along with students. Self-care Physical With the increasing prevalence of depressive symptoms in youth, there is an amplified need to ensure their physical health is addressed. Conventional treatments for depression are only effective in one out of three cases making it critical for families to address the issue using a holistic approach (Lassale et al., 2019). Adopting and maintaining healthy behaviors in the care of the physical body have been shown as effective measures in the prevention and treatment of depression. Adolescents between the age of 12 and 18 years old participated in research to study the relationship between healthy habits and mental health outcomes (Maenhout et al., 2020). In a questionnaire, items indicating a healthy lifestyle included physical activity, healthy diet, quality sleep, and abstinence from drugs, alcohol, and tobacco. Mental health measures assessed symptoms of depression, anxiety, stress, and self-esteem. The results showed that all healthy lifestyle choices were associated with at least one of the positive mental health outcomes and in 14 general a healthy lifestyle was indicative of a healthy mental state (Maenhout et al., 2020). Similarly, a meta-analysis of 13 studies found that alcohol, cannabis, illicit drugs, tobacco use, and unhealthy levels on the body mass index (BMI) were all associated with increased symptoms of depression (Cairns et al., 2014). Furthermore, Cairns et al. (2014), found lower levels of depressive symptoms in adolescents who identified a healthy diet, getting enough sleep, and participating in sports. A healthy diet is difficult to quantify. However, there is research to suggest specific components to avoid as well as suggestions on healthy choices to include within a diet. Trans fatty acids, commonly found in fast food and commercially prepared bakery items (Sanchez-Villegas et al., 2013) are at the top of the list of foods to avoid. Food items that are highly processed or contain trans-fat are considered inflammatory and cause a reaction in our body which interferes with regular brain function. Good fats like omega-3 fatty acids, found in fish and flaxseed, and olive oil should be included in the diet as a protective factor as they are associated with lower levels of depressive symptoms. A diet focused on consuming vegetables, fish, healthy fats, and unprocessed starches, like those recommended by the Mediterranean diet, can substantially help in reducing symptoms of depression (Lassale et al., 2019; Sanchez-Villegas et al., 2013). In an analysis of 30 high quality studies, 25 studies showed that physical activity was negatively associated with depression (Mammen & Faulkner, 2013). Even low levels of activity were shown to help stave off the recurrence of depression for those in remission. Maintaining or establishing healthy physical activity habits are a key strategy in the treatment and prevention of depression (Mammen & Faulkner, 2013). 15 Physically active youth are significantly more likely to have positive self-esteem (Tremblay et al., 2000). When both young males and females increased their vigorous activity, they benefited from a progressive boost in their self-esteem. Not surprising, youth who increased their physical activity not only experienced a mood boost but a decrease in their BMI (Tremblay et al., 2000). Physical activity could also benefit mood by preparing the youth’s body for better sleep quality (Rohde, 2015). Adolescents should receive around nine hours of sleep per night to achieve optimal rest (Fuligni et al., 2018; Blake et al., 2018). Insomnia, a chronic lack of quality and quantity of sleep, is the most common sleep disorder among teens with 53% reporting less than eight hours of sleep on school nights and 36 % indicating challenges falling asleep (Blake et al., 2018; Johnson et al., 2006). Sleep disturbance is one of the key risk factors in the early symptoms of mental health problems with adolescents (Kaneita et al., 2009). Persistent sleep disturbance, including night awakening, difficulty falling asleep, less hours for sleep, and getting to bed later, over a two-year period is a considerable risk factor for issues with mental health (Kaneita et al., 2009; Qiu & Morales-Muñoz, 2022). Over 50% of adolescents with insomnia also present comorbidity in depression, anxiety, or another psychiatric disorder (Shochat et al., 2014; McMakin & Alfano, 2015; Qiu & Morales-Muñoz, 2022). Several factors contribute to the adolescent's vulnerability to insomnia including uncontrollable factors related to puberty with changes in sleep drive and the circadian sleep/wake cycle is altered, making the body naturally want to stay up later (Blake et al., 2018; Carskadon et al., 2004; Feinberg et al., 2006). Conditions contributing to insomnia can also be derived from the adolescent’s greater degree of autonomy. This includes the increase in social interests and responsibilities, the decline in parental control over bedtime, the increase of electronic devices, and the increase of caffeine 16 intake (Blake et al., 2018; Adam et al., 2007; Maume, 2013; Bartel et al., 2015; Short et al., 2011; Hale & Guan, 2015). Research suggests that Cognitive Behavior Therapy for Insomnia (CBT-I) is one of the most effective treatments for insomnia in adults and teens (Blake et al., 2017; Blake et al., 2018; Edinger et al., 2005; Qaseem et al., 2016). The practices taught in CBT-I include sleep education, sleep hygiene, restricting sleep to bedtime, reducing stimulating activities around bedtime, body and mind relaxation, and addressing misconceptions (Blake et al., 2018; Edinger & Means, 2005). Participants of CBT-I have observed improvements in their sleep, mental well-being, anxiety, and depression (Ballesio et al., 2018; Blake et al., 2018; Taylor & Pruiksma, 2014; Trauer et al., 2015; van Straten et al., 2018). In trials, the effectiveness of CBT-I is similar to the use of medications for sleeping disorders however, unlike the medications, the benefits continue after treatment ceases (Blake et al., 2018; Huedo-Medina et al., 2012; Nowell et al., 1997; Sivertsen et al., 2006). Teens who implemented CBT-I interventions increased the quality and quantity of sleep which led to an increase in feelings of well-being. Emotional An important aspect of well-being is observing emotional self-care. Having an overall feeling of gratitude about circumstances in life is linked to high feelings of emotional well-being and feeling less affected by negative emotions (Portocarrero, 2020). A study by Ramirez et al. (2014) found that a focus on gratitude and forgiveness strengthened good memories, increased well-being, and reduced depression. In another study, the participants were asked to record in a gratitude journal three good things each day and why they were perceived as being positive. At the end of the 14-day trial the participants reported higher levels of eudaimonic well-being, lower levels of stress, and increased feelings of well-being (Killen & Macaskill, 2015). Similarly, 17 Ho et al. (2014) found that gratitude, optimism, and savoring could be taught through activities resulting in reduced depression and an increase in life satisfaction resulting in greater feelings of well-being. The idea of training gratitude, optimism, and savoring was further explored by Salces-Cubero et al. (2018). In the study four groups were instructed and led in activities focused on gratitude, optimism, savoring, and a control group with the usual activities in a community center. The gratitude group showed a decrease in depression, anxiety, and negative affect, with an increase in positive affect, life satisfaction, happiness, and resilience. The savoring group experienced a dramatic drop in depression, anxiety, and negative effect directly after the intervention, but the effects were diminished at the one-month post assessment. The positive effects of savoring increased through the trial and persisted in the one-month posttest (Salces-Cubero et al., 2018). Savoring leads the individual to focus on happy moments and increase feelings of gratitude (Cheung & Lau, 2021). Cheung and Lau (2021) found that focusing on the positive life events led participants to recognize more good in their lives, increasing their ability to savor and see the positive in the future. Like savoring, mindfulness encourages the participant to slow down and experience a moment more fully. Mindfulness is the practice of paying attention to your thoughts, emotions, and body in the moment without passing judgment (Cheung & Lau, 2021). A study of over 5,000 participants in 83 countries found that people are estimated to be in a state of distraction for 47% of their waking life (Killingsworth & Gilbert, 2010). This study also showed being in a state of distraction is associated with lower feelings of well-being. A distracted mind contributes to feelings of stress, anxiety, and depression (Hoffman et al., 2016; Seli et al., 2019). Not surprisingly, mindful individuals are more likely to notice the positive experiences in their lives 18 and feel appreciation for the positive (Emmons & Stern, 2013; Ivtzan et al., 2016; Swickert et al., 2019). Mindfulness practice trains the individuals to remove themselves from autopilot, increasing self-regulation and promoting positive emotions (Teasdales et al. 1995). Through mindfulness practice, the individual can train himself or herself to recognize when their mind is wandering and redirect thought back to the present activity (Zedelius et al., 2015). This mindfulness also allows the individual to deepen their mind-body connection resulting in benefits for their physical, mental, and emotional well-being (Cheung & Lau, 2021; Gross, 2015). Mindfulness interventions relieve symptoms of anxiety, reduce stress and pain, lower depression, and increase emotional self-regulation (Goldberg et al., 2018; Goyal et al., 2014). Guided practice using the mindfulness mobile applications Headspace and Smiling Mind were used to study feelings of depression, anxiety, stress, resilience, and mindfulness (Flett et al., 2019). When used consistently over the first ten days of the study Headspace and Smiling Mind were found to increase feelings of well-being. In contrast, the control group, who recorded activities from the previous week, experienced an increase in stress and depression. Zollars et al. (2019) studied the effects of 10 minutes of daily use of the Headspace app over a four-week study. The participants were students in a pharmacist training program during the month of final examinations. At the end of the study, the participants reported increased mindfulness, lower stress, and greater feelings of well-being attributed to the mindfulness practices. Cunningham et al. (2021) held group sessions with adolescents to teach mind body skills. The group met once per week for 10 weeks with encouraging results. Following the limited interaction, 84% of participants reported that the group sessions helped them and in a three-month follow-up, the participants reported continued benefits. Benefits to participants 19 included learning valuable skills, feeling connected to others, being more in touch with their emotions, and feeling more hopeful. According to a meta-analysis conducted by van Agteren et al. (2021) mindfulness-based interventions and Positive Psychology Interventions were shown to have the greatest impact on improving feelings of well-being. The review aimed to discover the best methods for the treatment of depression in a clinical and non-clinical environment. The quantitative analysis included 393 studies totaling 53,288 participants. Mindfulness interventions yielded the largest benefit to the general population and those identified as mentally ill. PPIs were identified as the most impactful intervention with physically ill populations, followed in effectiveness by mindfulness interventions (van Agteren et al., 2021). The benefits of these interventions were demonstrated in clinical and non-clinical settings showing that the practices can be propitious in the classroom. Social Connection Humans are social by nature. Born into family and community units, perceptions of self and the world are largely based on our social interactions. It is proposed that security in our relationships is a basic human need to survive; in its absence there is isolation, loneliness, and vulnerability (Hawkley & Cacioppo, 2010). Therefore, it is no surprise that the presence of positive social interactions and relationships are closely related to feelings of well-being (Orben et al., 2020; Ryff, 2014). Individuals who foster positive social relationships are better protected from psychological issues like depression, anxiety, and addictive behaviors (Holt-Lunstad et al., 2010; Santini et al., 2015; Tao et al., 2013). Community and school closures as well as stay at home orders during the COVID-19 pandemic left youth feeling socially disconnected leading to increased feelings of depression (McMahon et al., 2022). 20 Feelings of loneliness can be a common experience in adolescence (Hawkley & Cacioppo, 2010). Loneliness is about the individual’s perception of social interactions and satisfaction with relationships. A person can be lonely surrounded by friends or can live relatively solitary lives without loneliness. Moments of loneliness are expected but a chronic episode of loneliness is detrimental to cognitive processing, emotional well-being, behavior-response, and physical health. Feelings of loneliness are associated with depression and might seem reciprocal, but duplicated studies have shown this is not the case. While loneliness is a predictor of future onset depression, the same is not true of depression as a predictor of loneliness. In fact, a study induced feelings of loneliness to the participants and the result was reports of increased stress, fear, anxiety, anger, pessimistic views, and lower self-esteem (Hawkley & Cacioppo, 2010). Occasional feelings of loneliness are common but there are ways to combat the situation and prevent a chronic issue. Individuals who feel lonely might be ultra-concentrated on their own attributes and situation. Focusing on the positive attributes and positive actions of others has been shown to lead to greater feelings of connection and perceived social support (Wood et al., 2008). Those who foster caring and concern for others through empathy are more likely to experience higher levels of well-being (Morelli et al., 2015). Canevello and Crocker (2015) studied this relationship between empathy and feelings of well-being. Among same-sex college roommates they tracked the individual’s goals; noting whether they were “self-image” goals or “compassionate” goals. Over 21 days the subjects self-reported their goals and rated aspects of their well-being. Participants who focused on self-image reported feelings of conflict, confusion, and fear. They also viewed others as competitors and felt uneasy with social interactions. In contrast, those who focused on compassionate goals had increased feelings of self-esteem, were 21 better able to work through social problems, and had positive emotions associated with social interactions (Canevello & Crocker, 2015). Taking the premise of empathy a little further, generosity through charitable donations was found to be the best predictor of life satisfaction in over one million people surveyed across 150 countries (Helliwell et al., 2017). An underlying theme of increasing social connection is to think and act in a way that is beneficial for the group not just the individual self. Feeling connected to others and society leads to increased feelings of well-being. Purpose The effects of the COVID-19 pandemic have left a lingering negative impact on the emotional well-being of adolescents. During the COVID-19 pandemic there was added stress on families and individuals as they faced physical, financial, and emotional distress. This global epidemic came at a time in children’s development when they are already vulnerable to depression and anxiety. The lack of social interaction and restrictions on regular activities added to the prevalence of depression and anxiety on a global scale. The purpose of this curriculum project is to develop content for use in secondary schools to teach research validated practices for improving well-being in adolescents. The research presented supports the effectiveness of interventions used with adolescents ranging from 12 to 19 years old. The severity of depression (Ma et al., 2021) and the benefits of interventions (Rohde, 2015) were more pronounced in later teenage years, making secondary schools the ideal time to intercede with teaching best practices in mental health. The curriculum was designed to facilitate learning in a group setting, making it accessible to a large portion of the student body. Within the group facilitation, there were opportunities for individual application, providing a more meaningful and lasting experience for the student. 22 Methods There is a need for a curriculum in secondary schools that addresses the well-being needs of the students in the classroom setting. This project addresses this need through the creation of 16 modules focused on practices identified to increase feelings of well-being including elements of: growth mindset, resiliency, and self-care. Context The curriculum was designed to be delivered to high school students as a credit bearing elective or health education class that would be counted toward graduation. The content would be taught over one semester lasting approximately 18 weeks. High school schedules with an eight-period block structure would have four classes meeting on A-day and four classes on B-day. Students attend this course every other day for the duration of a 1.5-hour class period. This curriculum was designed to be delivered in an in-person/class format. However, materials and assignments are available online and can be made accessible to students needing remote access. Scope It is essential that we take a whole child approach in preparing students to meet their academic and transitional goals. The curriculum for this project consists of instructional materials for increasing student’s understanding and exposure with research validated practices that promote well-being. The curriculum covers a semester course spanning 18 weeks with 16 subjects covered and time allowed for summative assessments at the beginning, mid-point, and end of the semester. Specifically, the materials focus on developing a growth mindset, resiliency building, and the importance of self-care habits. These topics are closely associated with elements of CBT. 23 Therefore, this curriculum pulled applicable practices into the design for students to benefit from CBT research findings, without the need for a licensed therapist. The materials included data and students are required to: design and carry out action projects, record journal prompts, engage in group learning activities, and make connections between classroom learning and personal life. Evaluation The curriculum was evaluated by six education experts. The experts included two high school teachers, two school psychologists, and two school administrators. The evaluators were given access to the curriculum through a Canvas course and asked to provide feedback by answering questions in an online survey (see Appendix A). Procedures The curriculum was developed using the online learning platform Canvas under the title, “Foundations of Well-Being.” The Canvas course contains modules covering 16 content areas that can be delivered over a semester. The content topic areas include: 1. What is Well-Being? 2. Action Brings Change 3. Rethinking Perceptions 4. Growth Mindset and Flow 5. Grit 6. Resiliency 7. Hope and Optimism 8. Character Strengths and Resources 24 9. Keeping Perspective 10. Sleep 11. Physical Activity 12. Nutrition 13. Mindfulness 14. Savoring and Gratitude 15. Social Connection 16. Healthy relationships. The researcher included the following for enrichment and development of subject matter in each content area: a. Short video with learning outcomes to preview the beginning of the module (for a screenshot of an example see Appendix B) b. Background information and research surrounding the concept or practice with a Nearpod interactive multimedia experience (for slides of an example Nearpod see Appendix C) c. Assignment for individualized reflection and deeper understanding of concepts (for an example see Appendix D) d. Journal prompts to promote introspection and personalized learning (for an example see Appendix E) e. Group activities (for an example see Appendix F) f. Home Connection to make the lasting connection between class concepts and personal lives (for an example see Appendix G). 25 The course outlined the two Personal Action Research Projects (PARP) to be completed at the end of the first and second term. The PARP requires each student to take a deeper dive into a content area of their choosing (for examples of assignment supports and grading rubric see Appendix H). Results The curriculum was evaluated by experts who were invited to give feedback on the course. The experts were granted unlimited access to the Canvas course and provided with a link to an online survey (Appendix A) to provide feedback. Learning Outcomes The survey prompted the evaluators to answer questions regarding the alignment with course outcomes. Questions two, four, and seven on the survey assessed effectiveness in curriculum alignment with learning outcomes. All survey responses regarding learning outcomes responded with a “strongly agree” or “agree” to the learning outcome statement. With 86.1% of the expert evaluators indicating they strongly agree that the course supports student learning outcomes. Based on evaluator feedback, the curriculum was adjusted to include a brief video introduction at the beginning of each module. The introduction used Adobe Character Animator to introduce the learning objectives for the module. This addition is intended to increase learner engagement and understanding of learning outcomes. Accessibility Survey questions three, five, and six address the ease of incorporating the course into the classroom setting. Question three inquired about the ease of data collection. All the evaluators “strongly agreed” that the curriculum provided effective assessment data collection. 26 Five of the respondents “strongly agree” that the curriculum is clear and easy to follow, with one indicating they “agree.” When asked if they agree that the activities could feasibly be carried out in the classroom all, but one, responded that they “strongly agree” or “agree” (four and one respondents, respectively). The exception came from a school psychologist who marked “neither agree nor disagree.” This may be due to the nature of the job structure for a school psychologist. The school psychologist will typically pull students out of the classroom and work with them one-on-one or in a small group setting. The evaluator may not have felt qualified to respond to a statement about classroom feasibility, with the lack of experience in classroom-wide instruction as a teacher. Module Topics The next set of questions (8-12) assessed the value of the topics in the course modules. When asked which topics are of most worth to the students the top response was developing resiliency followed by growth mindset, understanding well-being, and sleep. Two evaluators suggested further development of understanding well-being, resiliency, and physical activity. Questions nine and ten provided the evaluators an opportunity to provide input if they felt a content area was missing and should be included or if they felt a content area was not needed and should be removed. It was suggested that more content regarding social media (e.g., Facebook, Snapchat, Instagram) and cell phone use be added to improve the course. Another suggestion was the addition of a module on the positive effects of connecting with nature. To make room for another module it was recommended that grit and resilience could be combined into one module. Evaluator feedback expressed a need for the PARP to be introduced earlier and provide more support. It was recommended that the learner could benefit from a grading rubric and a 27 graphic organizer to guide them through the project. Instructions on the PARP along with supportive materials were added to the welcome module (Appendix H). Introducing the project at the beginning of the course will facilitate a more meaningful PARP experience for the students. Potential for Impact The survey assessed whether the evaluator felt the curriculum has the potential to positively impact the mental health and well-being of high school students. Five out of six evaluators indicated “strongly agree” with the curriculum’s potential to make an impact on the well-being of high school students. The sixth respondent indicated they “agree” with the statement. Likewise, five out of six “strongly agree” that the curriculum is relevant to students’ needs and is necessary to student success, currently and in the future. While one evaluator marked “agree” to the statement. Discussion The results from evaluators indicate that the curriculum is in line with best practices for improving well-being in students, is well designed, and easy to follow. The curriculum was developed with and follows research-validated practices for improving well-being. Implications The curriculum contains a welcome module, 16 content area modules, and modules pertaining to end of term assessments. The purpose of the curriculum is to inform students of best practices and give opportunities for engagement in specific behaviors that promote well-being. The curriculum is not intended to meet any clinical needs that would be more appropriately addressed with a licensed professional. The curriculum is not for diagnosing or to 28 fulfill prescriptive treatment of mental health issues. However, this curriculum is intended to benefit a wide variety of students with various challenges, strengths, and situations in life. The practices found in the curriculum have been shown to be universally beneficial and have the potential to benefit a wide variety of students throughout all stages of life. The curriculum is easily accessible using Canvas, the learning management system (LMS) used in the local school district. The online platform allows for the sharing of curriculum including lesson materials, assignments, and assessments. Using the Canvas form factor creates a low time cost investment for teachers to begin teaching this curriculum in high schools. Canvas also provides a platform that allows the curriculum to be highly customizable, to meet the needs of the teacher and maximize student learning opportunities. The scope of the curriculum allowed the instruction to focus on a broad picture of how to improve feelings of well-being. The current requirements of the Health II standards only focus a small portion of the curriculum on practices that can help to improve feelings of well-being. In contrast, there are commercially prepared programs that become hyper-focused on one aspect, or one practice related to well-being. This course draws from a variety of research practices to bring together a well-rounded look at behaviors that lead to increased feelings of well-being in life. Two critical components of this curriculum are the home-connection assignments and the PARP. To make an enduring change, the students need to take the concepts learned in class and apply them to their personal lives. The home-connection assignments and PARPs are the pieces that will help the students to bridge a connection between the academic concept and a testimonial of the transformative power found in a practice. Through home practice and reporting on their experience, I believe that students will gain the skills necessary to face challenges they experience throughout life. 29 Recommendations With the complexity of the human mind, there is no way to compile a comprehensive list of practices necessary to maintaining positive mental health for every individual. This curriculum was developed with the intention of facilitating a basis of research validated practices that can be used as a foundation for this course. As research continues and society evolves so will our needs for support and instruction. The importance of feeling connected with nature was suggested by one of the evaluators. Exposure to nature is widely accepted as helping to prevent and reduce symptoms of a variety of health conditions (Joschko et al., 2023; Laguaite, 2021). According to the research, “being in a green space has been linked to less anxiety, fewer depression symptoms, and lower stress levels. Spending time in nature helps people with depression and kids with attention problems think more clearly” (Laguaite, 2021). A module on the benefits of spending time in nature with outdoor class time would be a beneficial addition to the curriculum in the future. Limitations A limitation of this project is the evaluation process which used a small convenience sampling to evaluate the curriculum. Expert evaluators were invited from a pool of local colleagues and were chosen based on availability and willingness to participate. This self-selecting may introduce bias as evaluators who have more of an interest in mental health awareness may rate the course more favorably. The small sample size also limits the statistical power of evaluator responses. Further research and implementation of the curriculum will yield more statistically relevant data. A school psychologist expressed a concern about student “buy-in.” This is always a concern when introducing students to new habits. To address this limitation a page was added to 30 the course with suggestions for instructors on how to increase student “buy-in.” The evaluator also suggested that the student self-assessments may help students to see a need and therefore increase their motivation to apply the skills being taught. Additionally, it is recommended that the next step is to put the curriculum into action. Teaching the curriculum in a classroom will help to flesh out any unforeseen strengths and weaknesses in the course. Future improvements to the course would include the integration of technology to further engage students of this era. For example, podcast recordings to enrich the content in modules could be one approach. A podcast would be an excellent opportunity to interview a member of the community who is an example of everyday resiliency. One of the evaluators suggested the need for examples of “everyday resiliency” because students often think of resiliency only applying to the big moments in life. An interview with a member of the community would help to bring the concept into focus and make it more applicable to the student. Integration of technology, like podcasts, helps students to engage in the content in a novel way and solidify concepts. Conclusion Community-wide quarantines, school closures, and disruptions to daily routines, negatively affected the well-being of adolescents due to the COVID-19 pandemic. This created a lasting impact on the well-being and health of an already vulnerable population of adolescents. This curriculum project focuses on research validated practices that have empirical support proven to increase feelings of well-being in adolescents. The offering of this course to students in secondary schools as a health elective would provide a large portion of the student body with access to information of best practices necessary for maintaining positive feelings of well-being. The format for this course delivery will be a combination of whole group along with 31 individualized and home application, providing the students opportunities to gain practice and skills in behaviors that lead to lasting well-being. The course materials are available through Canvas which will help make the curriculum easily adopted by teachers and customized to meet their students’ needs. The modules are set up to fit within an 18-week semester, but timelines can be customized to be accelerated or stretched beyond the 18 weeks. There has always been a need to support youth as they transition to adulthood. Adolescence is a challenging time, when youth are faced with many changes to their brain chemistry, bodies, priorities, and environments. The COVID-19 pandemic did not create a new problem but highlighted and exacerbated an already challenging dynamic of life. Youth can benefit from explicit instruction and engagement with the curriculum found in this course, “Foundations of Well-Being.” 32 References Adam, E. K., Snell, E. K., & Pendry, P. (2007). Sleep timing and quantity in ecological and family context: A nationally representative time-diary study. Journal of Family Psychology 21(1), 4-19. https://doi.org/10.1037/0893-3200.21.1.4 Allen, J. P., Chango, J., Szwedo, D., & Schad, M. (2014). Long-term sequelae of subclinical depressive symptoms in early adolescence. Development and Psychopathology, 26(1), 171-180. https://doi.org/10.1017/S095457941300093X American Psychological Association. (n.d.). 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Currents in Pharmacy Teaching and Learning, 11(10), 1022-1028. https://doi.org/10.1016/j.cptl.2019.06.005 53 Appendix A Evaluation Form Link to form: https://forms.office.com/r/ZddqctCGGK 54 55 56 57 58 59 Appendix B Screen Shot of Example Learning Outcomes Video 60 Appendix C Slides from an Example Nearpod Lesson 61 62 63 64 65 66 67 68 69 70 71 72 73 74 Appendix D Example Assignment 75 76 77 78 Appendix E Example Journal Prompt 79 Appendix F Example Group Activity 80 Appendix G Example Home Connection 81 82 Appendix H Personal Action Research Project Examples of support to student learning and the grading rubric. 83 84 85 86