The Role of Pediatric Nurses in the Effectiveness of School-Based Emotion Regulation Programs on Anxiety, Depression, and Well-Being

Year 2025, Volume: 7 Issue: 2, 58 - 68, 29.09.2025

Merve Oral , Ebru Kılıçarslan Törüner

https://doi.org/10.59124/guhes.1690978

Abstract

Adolescence is a developmental stage characterized by intense emotional fluctuations and heightened psychological sensitivity. Acquiring effective emotion regulation skills during this period plays a critical role in preventing internalizing problems such as anxiety and depression. This systematic review examines the impact of school-based emotion regulation interventions on adolescents' psychological well-being, anxiety, and depression levels, and discusses the role of pediatric nurses in these programs. The findings indicate that structured intervention programs are effective in reducing psychological symptoms and promoting positive attributes. These interventions include cognitive behavioral therapy, mindfulness-based approaches, psychoeducation, and physical activities. Pediatric nurses contribute significantly in this process through their roles as educators, counselors, caregivers, protectors, and innovators. Particularly in school-based interventions, they can guide students in developing emotional awareness, enhancing coping skills, and fostering healthy social relationships. In conclusion, increasing the visibility and functionality of pediatric nurses in school-based mental health services presents a valuable opportunity to strengthen the community's overall psychological well-being.

Keywords

Adolescent , anxiety , depression , emotion regulation , pediatric nurse , well-being

Ethical Statement

There is no need to obtain ethics committee permission for this study due review. However, the study was conducted in accordance with ethical principles.

Supporting Institution

This study did not receive any financial support.

References

• Akdemir, A., & Gunduz, B. (2022). The effect of emotion regulation skills psychoeducation program on emotion regulation difficulties and reactive-proactive aggressions of adolescents. Education and Science, 47(209), 311-334. https://doi.org/10.15390/EB.2022.9048
• Al Sharif, A. A., Al Buainain, H. S., Al Buainain, A. S., Al Tanbakti, R. M. A., Abdul Aziz, K. S., Majrashi, J. A., Alharthi, A. O., Alotaibi, H. A., Adawai, A. H. A., & Al-Ghamdi, M. A. (2024). The role of pediatric nurses in promoting child health and well-being. Journal of International Crisis and Risk Communication Research, 7(1), 164–170. https://doi.org/10.63278/jicrcr.vi.634
• Aldao, A., Nolen-Hoeksema, S., & Schweizer, S. (2010). Emotion-regulation strategies across psychopathology: A meta-analytic review. Clinical Psychology Review, 30(2), 217–237. https://doi.org/10.1016/j.cpr.2009.11.004
• American Academy of Pediatrics (AAP). (2016). Role of the School Nurse in Providing School Health Services. Pediatrics,137(6),e20160852. https://doi.org/10.1542/peds.2016-0852
• Areskoug Sandberg, E., Stenman, E., Palmer, K. et al. (2024). A 10-Week School-Based Mindfulness Intervention and Symptoms of Depression and Anxiety Among School Children and Adolescents: A Controlled Study. School Mental Health 16, 936–947. https://doi.org/10.1007/s12310-023-09620-y
• Brown, J., James, K., Lisk, S., Shearer, J., Byford, S., Stallard, P., Deighton, J., Saunders, D., Yarrum, J., Fonagy, P., Weaver, T., Sclare, I., Day, C., Evans, C., & Carter, B. (2024). Clinical effectiveness and cost-effectiveness of a brief accessible cognitive behavioural therapy programme for stress in school-aged adolescents (BESST): a cluster randomised controlled trial in the UK. The Lancet. Psychiatry, 11(7), 504–515. https://doi.org/10.1016/S2215-0366(24)00101-9
• Burckhardt, R., Manicavasagar, V., Batterham, P. J., & Hadzi-Pavlovic, D. (2016). A randomized controlled trial of strong minds: A school-based mental health program combining acceptance and commitment therapy and positive psychology. Journal of School Psychology, 57, 41–52. https://doi.org/10.1016/j.jsp.2016.05.008
• Caldwell, D. M., Davies, S. R., Hetrick, S. E., Palmer, J. C., Caro, P., López-López, J. A., Gunnell, D., Kidger, J., Thomas, J., French, C., Stockings, E., Campbell, R., & Welton, N. J. (2019). School-based interventions to prevent anxiety and depression in children and young people: a systematic review and network meta-analysis. The Lancet. Psychiatry, 6(12), 1011–1020. https://doi.org/10.1016/S2215-0366(19)30403-1
• Carissoli, C., & Villani, D. (2019). Can Videogames Be Used to Promote Emotional Intelligence in Teenagers? Results from EmotivaMente, a School Program. Games for Health Journal, 8(6), 407-413. https://doi.org/10.1089/g4h.2018.0148
• Claro, A., Boulanger, M.-M., & Shaw, S. R. (2015). Targeting Vulnerabilities to Risky Behavior: an Intervention for Promoting Adaptive Emotion Regulation in Adolescents. Contemporary School Psychology, 19(4), 330-339. https://doi.org/10.1007/s40688-015-0063-9
• Chen, Y. Y., Ting, C. H., Ghazali, S. R., & Ling, A. A. (2024). Enhancing children's well‐being using malaysian‐adapted version super skills for life (m‐ssl) among primary school children in malaysia. Psychology in the Schools. Advance online publication. https://doi.org/10.1002/pits.23258
• Cheng, C., Li, S., & Chen, S. (2024). Evaluation of a multicomponent positive psychology program to prevent gaming disorder and enhance mental wellness in primary pupils: A randomized controlled trial. Journal of Behavioral Addictions, 13(3), 871–883. https://doi.org/10.1556/2006.2024.00052
• Compas, B. E., Jaser, S. S., Bettis, A. H., Watson, K. H., Gruhn, M., Dunbar, J. P., ... & Thigpen, J. C. (2017). Coping, emotion regulation, and psychopathology in childhood and adolescence: A meta-analysis and narrative review. Psychological Bulletin, 143(9), 939–991. https://doi.org/10.1037/bul0000110
• Cracco, E., Goossens, L., & Braet, C. (2017). Emotion regulation across childhood and adolescence: evidence for a maladaptive shift in adolescence. European Child and Adolescent Psychiatry, 26(8), 909-921. https://doi.org/10.1007/s00787-017-0952-8
• Daly, L. A., Haden, S. C., Hagins, M., Papouchis, N., & Ramirez, P. M. (2015). Yoga and emotion regulation in high school students: A randomized controlled trial. Evidence-based Complementary and Alternative Medicine, 2015. https://doi.org/10.1155/2015/794928
• de la Torre-Luque, A., Fiol-Veny, A., Essau, C. A., Balle, M., & Bornas, X. (2020). Effects of a transdiagnostic cognitive behaviour therapy-based programme on the natural course of anxiety symptoms in adolescence. Journal of Affective Disorders, 264, 474–482. https://doi.org/10.1016/j.jad.2019.11.078
• Dowling, K., Simpkin, A. J., & Barry, M. M. (2019). A Cluster Randomized-Controlled Trial of the MindOut Social and Emotional Learning Program for Disadvantaged Post-Primary School Students. Journal of Youth and Adolescence, 48(7), 1245–1263. https://doi.org/10.1007/s10964-019-00987-3
• Eadeh, H. M., Breaux, R., & Nikolas, M. A. (2021). A Meta-Analytic Review of Emotion Regulation Focused Psychosocial Interventions for Adolescents. Clinical Child and Family Psychology Review (C. 24, Sayı 4, ss. 684-706). Springer. https://doi.org/10.1007/s10567-021-00362-4
• Essau, C. A., Sasagawa, S., Jones, G., Fernandes, B., & Ollendick, T. H. (2019). Evaluating the real-world effectiveness of a cognitive behavior therapy-based transdiagnostic program for emotional problems in children in a regular school setting. Journal of Affective Disorders, 253, 357–365. https://doi.org/10.1016/j.jad.2019.04.036
• Frank, J.L., Kohler, K., Peal, A. et al. (2017). Effectiveness of a School-Based Yoga Program on Adolescent Mental Health and School Performance: Findings from a Randomized Controlled Trial. Mindfulness 8, 544–553. https://doi.org/10.1007/s12671-016-0628-3
• Fung, J., Kim, J. J., Jin, J., Chen, G., Bear, L., & Lau, A. S. (2019). A Randomized Trial Evaluating School-Based Mindfulness Intervention for Ethnic Minority Youth: Exploring Mediators and Moderators of Intervention Effects. Journal of Abnormal Child Psychology, 47(1), 1-19. https://doi.org/10.1007/s10802-018-0425-7
• Gross, J. J. (2015). Emotion regulation: Current status and future prospects. Psychological Inquiry, 26(1), 1–26. https://doi.org/10.1080/1047840X.2014.940781
• Gómez-Restrepo, C., Sarmiento-Suárez, M. J., Alba-Saavedra, M., Calvo-Valderrama, M. G., Rincón-Rodríguez, C. J., Bird, V. J., Priebe, S., & van Loggerenberg, F. (2023). Development and Implementation of DIALOG+S in the School Setting as a Tool for Promoting Adolescent Mental Well-Being and Resilience in a Post-Armed Conflict Area in Colombia: Exploratory Cluster Randomized Controlled Trial. JMIR Formative Research, 7, e46757. https://doi.org/10.2196/46757
• Guidelines on mental health promotive and preventive interventions for adolescents: helping adolescents thrive. Geneva: World Health Organization; 2020. Licence: CC BY-NC-SA 3.0 IGO.
• Houck, C. D., Barker, D. H., Hadley, W., Brown, L. K., Lansing, A., Almy, B., & Hancock, E. (2016). The 1-year impact of an emotion regulation intervention on early adolescent health risk behaviors. Health Psychology, 35(9), 1036-1045. https://doi.org/10.1037/hea0000360
• Huttunen, I., Upadyaya, K., & Salmela-Aro, K. (2025). Adolescents’ social-emotional skills profiles, relationships at school, school anxiety, and educational aspirations. European Journal of Psychology of Education, 40, Article 57. https://doi.org/10.1007/s10212-025-00954-6
• Iyer, R. B., & Iyer, B. N. (2019). The impact of heartfulness-based elective on middle school students. American Journal of Health Behavior, 43(4), 812-823. https://doi.org/10.5993/AJHB.43.4.14
• Jordans, M. J., Tol, W. A., Ndayisaba, A., & Komproe, I. H. (2013). A controlled evaluation of a brief parenting psychoeducation intervention in Burundi. Social Psychiatry and Psychiatric Epidemiology, 48(11), 1851–1859. https://doi.org/10.1007/s00127-012-0630-6
• James, K., Lisk, S., Payne-Cook, C., Farishta, Z., Farrelly, M., Sheikh, A., Slusarczyk, M., Byford, S., Day, C., Deighton, J., Evans, C., Fonagy, P., Saunders, D., Sclare, I., Shearer, J., Stallard, P., Weaver, T., Yarrum, J., Carter, B., & Brown, J. S. L. (2024). Brief Educational Workshops in Secondary Schools Trial (BESST trial), a school-based cluster randomised controlled trial of the DISCOVER workshop for 16-18-year-olds: recruitment and baseline characteristics. Trials, 25(1), 302. https://doi.org/10.1186/s13063-024-08116-7
• Johnstone, K. M., Middleton, T., Kemps, E., & Chen, J. (2020). A pilot investigation of universal school-based prevention programs for anxiety and depression symptomology in children: A randomized controlled trial. Journal of Clinical Psychology, 76(7), 1193–1216. https://doi.org/10.1002/jclp.22926
• Klim-Conforti, P., Zaheer, R., Levitt, A. J., Cheung, A. H., Schachar, R., Schaffer, A., Goldstein, B. I., Fefergrad, M., Niederkrotenthaler, T., & Sinyor, M. (2021). The Impact of a Harry Potter-Based Cognitive-Behavioral Therapy Skills Curriculum on Suicidality and Well-being in Middle Schoolers: A Randomized Controlled Trial. Journal of Affective Disorders, 286, 134–141. https://doi.org/10.1016/j.jad.2021.02.028
• Kozina A. (2020). School-based prevention of anxiety using the "My FRIENDS" emotional resilience program: Six-month follow-up. International journal of psychology : Journal Iinternational de Psychologie, 55 Suppl 1, 70–77. https://doi.org/10.1002/ijop.12553
• Kokonyei, G., Kovács, L. N., Szabó, J., & Urbán, R. (2024). Emotion Regulation Predicts Depressive Symptoms in Adolescents: A Prospective Study. Journal of Youth and Adolescence, 53(1), 142–158. https://doi.org/10.1007/s10964-023-01894-4
• Khunti, K., Boniface, S., Norris, E., De Oliveira, C. M., & Nicola Shelton (2023). The effects of yoga on mental health in school-aged children: A Systematic Review and Narrative Synthesis of Randomised Control Trials. Clinical Child Psychology and Psychiatry, 28(3), 1217–1238. https://doi.org/10.1177/13591045221136016
• Lam, K., & Seiden, D. (2020). Effects of a brief mindfulness curriculum on self-reported executive functioning and emotion regulation in Hong Kong adolescents. Mindfulness, 11(3), 627–642. https://doi.org/10.1007/s12671-019-01257-w
• Lappalainen, R., Lappalainen, P., Puolakanaho, A., Hirvonen, R., Eklund, K., Ahonen, T., Muotka, J., & Kiuru, N. (2021). The Youth Compass - the effectiveness of an online acceptance and commitment therapy program to promote adolescent mental health: A randomized controlled trial. Journal of Contextual Behavioral Science, 20, 1–12. https://doi.org/10.1016/j.jcbs.2021.01.007
• Lineberry, M. J., & Ickes, M. J. (2015). The role and impact of nurses in American elementary schools: A systematic review of the literature. Journal of School Nursing, 31(1), 22–33. https://doi.org/10.1177/1059840514540940
• Long, E., Zucca, C., & Sweeting, H. (2020). School climate, peer relationships, and adolescent mental health: A social ecological perspective. Youth & Society, 00(0), 1–16. https://doi.org/10.1177/0044118X20970232
• Lytle, M., Rau, W., & Stoner, S. (2024). The Role of the School Nurse in Social-Emotional Assessment and Intervention Using the MTSS Framework. NASN School Nurse (Print), 39(6), 306–314. https://doi.org/10.1177/1942602X241240499
• Maalouf, F. T., Alrojolah, L., Ghandour, L., Afifi, R., Dirani, L. A., Barrett, P., Nakkash, R., Shamseddeen, W., Tabaja, F., Yuen, C. M., & Becker, A. E. (2020). Building Emotional Resilience in Youth in Lebanon: a School-Based Randomized Controlled Trial of the FRIENDS Intervention. Prevention Science : The Official Journal of the Society for Prevention Research, 21(5), 650–660. https://doi.org/10.1007/s11121-020-01123-5
• Maughan, E. D., Johnson, K. H., Bergren, M. D., Wolfe, L. C., Cole, M., Pontius, D. J., Mendonca, L. L., Watts, E., & Patrick, K. (2014). Standardized data set for school health services: Part 1--getting to big data. NASN School Nurse (Print), 29(4), 182–186. https://doi.org/10.1177/1942602x14538414
• McLaughlin, K. A., Garrad, M. C., & Somerville, L. H. (2015). What develops during emotional development? A component process approach to identifying sources of psychopathology risk in adolescence. Dialogues in Clinical Neuroscience, 17(4), 403–410. https://doi.org/10.31887/DCNS.2015.17.4/kmclaughlin
• Moen, Ø. L., & Jacobsen, I. C. R. (2022). School Nurses' Experiences in Dealing with Adolescents Having Mental Health Problems. SAGE open nursing, 8, 23779608221124411. https://doi.org/10.1177/23779608221124411
• Monsillion, J., Zebdi, R., & Romo-Desprez, L. (2023). School Mindfulness-Based Interventions for Youth, and Considerations for Anxiety, Depression, and a Positive School Climate-A Systematic Literature Review. Children (Basel, Switzerland), 10(5), 861. https://doi.org/10.3390/children10050861
• Morrish, L., Rickard, N., Chin, T. C., & Vella-Brodrick, D. A. (2018). Emotion Regulation in Adolescent Well-Being and Positive Education. Journal of Happiness Studies (C. 19, Sayı 5, ss. 1543-1564). Springer Netherlands. https://doi.org/10.1007/s10902-017-9881-y
• Mulyati, H., Yusuf, S. L. N., & Supriatna, M. (2020). Emotion regulation in adolescents. In Proceedings of the International Conference on Educational Psychology and Pedagogy (ICEPP 2019). Advances in Social Science, Education and Humanities Research (Vol. 399, pp. 129–132). Atlantis Press. https://doi.org/10.2991/assehr.k.200130.097
• National Association of School Nurses, Tanner, A., Griffin, R., Stanislo, K. J., Hinkley, T., Walsh, C. A., Clark, E., Graf, K., La Point, R., & D'Souza-Vazirani, D. (2024). A Contemporary Framework Update for Today's School Nursing Landscape: Introducing the School Nursing Practice Framework™. NASN School Nurse (Print), 39(3), 140–147. https://doi.org/10.1177/1942602X241241092
• Pedrini, L., Meloni, S., Lanfredi, M., & Rossi, R. (2022). School-based interventions to improve emotional regulation skills in adolescent students: A systematic review. Journal of Adolescence (C. 94, Sayı 8, ss. 1051-1067). John Wiley and Sons Inc. https://doi.org/10.1002/jad.12090
• Rana, S., & Nandinee, D. (2016). Profile of Adolescents’ Positive Emotions: An Indicator of their Psychological Well-being. Psychological Studies, 61(1), 32-39. https://doi.org/10.1007/s12646-015-0347-1
• Rice, K. J., Chen, J., Kemps, E., Roberts, R. M., Edwards, S., & Johnstone, K. (2024). Two universal school-based prevention programs for depression and anxiety: 24-Month follow-up of an RCT. Journal of Behavior Therapy and Experimental Psychiatry, 85, 101985. https://doi.org/10.1016/j.jbtep.2024.101985
• Rodríguez-Ledo, C., Orejudo Hernández, S., Celma Pastor, L., & Cardoso Moreno, M. J. (2018). Improving social-emotional competencies in the secondary education classroom through the SEA program. Electronic Journal of Research in Educational Psychology, 16(46), 681–701. http://ojs.ual.es/ojs/index.php/EJREP/article/view/1485
• Russell, B. S., Hutchison, M., & Fusco, A. (2019). Emotion regulation outcomes and preliminary feasibility evidence from a mindfulness intervention for adolescent substance use. Journal of Child & Adolescent Substance Abuse, 28(1), 21–31. https://doi.org/10.1080/1067828X.2018.1561577
• Sanchez, B., Allen, D., & Delgado, J. (2023). Positive Psychological Effects of School-Based Yoga and Mindfulness Programs for At-Risk Hispanic Adolescents. Contemporary School Psychology, 27(1), 118–135. https://doi.org/10.1007/s40688-022-00427-3
• Scafuto, F., Ghiroldi, S., Montecucco, N. F., De Vincenzo, F., Quinto, R. M., Presaghi, F., & Iani, L. (2024). Promoting well-being in early adolescents through mindfulness: A cluster randomized controlled trial. Journal of adolescence, 96(1), 57–69. https://doi.org/10.1002/jad.12252
• Schoeps, K., Villanueva, L., Prado-Gascó, V. J., & Montoya-Castilla, I. (2018). Development of emotional skills in adolescents to prevent cyberbullying and improve subjective well-being. Frontiers in Psychology, 9(OCT). https://doi.org/10.3389/fpsyg.2018.02050
• Selcuk, H. N., & Aslan, S. (2022). Ergenlik dönemi, psikolojik zihinlilik, ebeveyne bağlanma stilleri ve aleksitimi kavramları üzerine bir derleme. Uluslararası Anadolu Sosyal Bilimler Dergisi, 6(2), 719-735. https://doi.org/10.47525/ulasbid.1097337
• Silvers, J. A. (2022). Adolescence as a pivotal period for emotion regulation development. Current Opinion in Psychology, 44, 258–263. https://doi.org/10.1016/j.copsyc.2021.09.023
• Singh, N., Minaie, M. G., Skvarc, D. R., & Toumbourou, J. W. (2019). Impact of a Secondary School Depression Prevention Curriculum on Adolescent Social-Emotional Skills: Evaluation of the Resilient Families Program. Journal of youth and adolescence, 48(6), 1100–1115. https://doi.org/10.1007/s10964-019-00992-6
• Stjernswärd, S., & Hansson, L. (2014). A web-based supportive intervention for families living with depression: content analysis and formative evaluation. JMIR research protocols, 3(1), e8. https://doi.org/10.2196/resprot.3051
• Tejada-Gallardo, C., Blasco-Belled, A., & Alsinet, C. (2022). Changes in the network structure of mental health after a multicomponent positive psychology intervention in adolescents: A moderated network analysis. Applied psychology. Health and well-being, 14(3), 987–1003. https://doi.org/10.1111/aphw.12363
• Theurel, A., & Gentaz, E. (2018). The regulation of emotions in adolescents: Age differences and emotion-specific patterns. PLoS ONE, 13(6). https://doi.org/10.1371/journal.pone.0195501
• van Loon, A. W. G., Creemers, H. E., Beumer, W. Y., Okorn, A., Vogelaar, S., Saab, N., Miers, A. C., Westenberg, P. M., & Asscher, J. J. (2020). Can schools reduce adolescent psychological stress? A multilevel meta-analysis of the effectiveness of school-based intervention programs. Journal of Youth and Adolescence, 49(6), 1127–1145. https://doi.org/10.1007/s10964-020-01201-5
• Verzeletti, C., Zammuner, V. L., Galli, C., & Agnoli, S. (2016). Emotion regulation strategies and psychosocial well-being in adolescence. Cogent Psychology, 3(1). https://doi.org/10.1080/23311908.2016.1199294
• Young, K. S., Sandman, C. F., & Craske, M. G. (2019). Positive and negative emotion regulation in adolescence: links to anxiety and depression. Brain Sciences (C. 9, Sayı 4). MDPI AG. https://doi.org/10.3390/brainsci9040076