In North America, the prevalence of psychological disorders in youth has risen over the past decade (National Institute of Mental Health, 2019). Major contributors directly affecting this prevalence are the increase in diagnoses, along with the lack of accessibility and affordability of mental health care (American Academy of Child and Adolescent Psychiatry, 2019). Moreover, only one in five children under the age of 12 receives adequate treatment for mental illness (Butler & Pang, 2014). As such, it has been recommended that empirical, evidence-based prevention strategies are developed and implemented in school settings to help foster greater well-being in youth and to render mental health services accessible to a larger number of children (Durlak, Weissberg, Dymnicki, Taylor, & Schellinger, 2011).
Fostering greater mental health, wellbeing and overall resiliency to stress has been strongly emphasized in both the American and Canadian elementary school systems (Gouvernement du Québec, 2007; United States Department of Education, 2011). Issues pertaining to psychological health and its impacts on academic success and perseverance are of central importance to all school actors and to youth’s parents alike. Decades of research in psychology, education and philosophy have shown multiple benefits that come from higher basic psychological need satisfaction in children, namely with regards to overall mental health, wellbeing and academic success (Ryan & Deci, 2000). Teachers’ interventions that aim to increase basic psychological need satisfaction have also shown promise in fostering better mental health in children in school settings (Deci, Schwartz, Sheinman, & Ryan, 1981; Niemiec & Ryan, 2009; Reeve & Halusic, 2009; Standage, Duda, & Ntoumanis, 2006).
In recent years, the concept of mental health has been best understood as comprised of both positive (e.g., basic psychological needs satisfaction and well-being) and negative indicators (i.e. symptoms of psychopathology such as anxiety, depression and inattention) (Westerhof & Keyes, 2010). In light of this distinction, in Canada, preventive strategies aiming to foster positive indicators of mental health in youth have gained in influence over the past years, namely because of such programs’ ability to prevent negative indicators of mental health from arising (Mental Health Commission of Canada, 2013). Given the fact that children spend the majority of their time in a school setting, school-based programs have been suggested as a promising option to promote well-being and increase basic psychological needs satisfaction, while preventing the development of negative indicators of mental health such as anxiety and depression in youth (Short & Manion, 2012). Namely, philosophy for children (P4C), a school-based approach that aims to develop children’s capacity to think by and for themselves, has shown promise in its ability to positively influence well-being and to prevent anxiety and depression (Rahdar, Pourghaz, & Marziyeh, 2018; Siddiqui, Gorard, & See, 2019; Vansieleghem & Kennedy, 2011).
Philosophy for children (P4C)
P4C was initially developed by Lipman in the 1970’s, and served as an educational program to promote critical thinking, caring and creative reasoning and inquiry in the educational environment (Lipman, 1985; Vansieleghem & Kennedy, 2011). The initial aim of P4C was to help students become reflective and critical thinkers, to gain mastery over their learning environment and thus to become more self-determined (Vansieleghem, 2014). As a result, the majority of the P4C literature to date focuses on validating P4C’s effectiveness with respect to academic and cognitive performance, although some have researched the impact of P4C on empathy, emotions and creativity (Colom, Moriyón, Magro, & Morilla, 2014; Yan, Walters, Wang, & Wang, 2018). Indeed, a recent meta-analysis assessing P4C’s effect on youth’s cognitive ability has suggested that P4C has a moderate, yet positive overall effect on both elementary and high school students’ learning and reasoning abilities (Yan et al., 2018).
While the cognitive benefits of P4C have been repeatedly empirically supported, literature addressing the positive psychological outcomes of P4C remains very limited (Siddiqui et al., 2019). A handful of quasi-experimental and correlational studies analyzing the psychological outcomes of P4C have emerged with time. These studies have shown, overall, that P4C has a positive effect on psychological outcomes such as self-efficacy, critical openness and relative skepticism (Rahdar et al., 2018), but also self-esteem (Sasseville & Gagnon, 2007; Topping & Trickey, 2007a, 2007b), resilience and happiness (Siddiqui et al., 2019). Despite the growing evidence of P4C’s impact on non-cognitive properties, the available literature remains quasi-experimental and thus lacks rigour to provide solid and valid evidence-based data supporting its implementation in school settings to foster greater wellbeing in children. As such, one aim of the present study was to evaluate whether a P4C intervention could be effective in fostering greater well-being in elementary school children using a randomized cluster trial.
Typically, P4C is delivered in a classroom setting and is facilitated by an educator (e.g., teacher, counsellor or school psychologist). During this time, students are presented with a philosophical primer, which can take multiple forms, such as a short story, a comic strip or a video clip introducing the philosophical theme to be discussed (Gagnon & Yergeau, 2016). Primers act to stimulate discussion - or philosophical dialogue - between children (Vansieleghem & Kennedy, 2011). Speech through dialogue is central to the practice of P4C, because it forms a “philosophical community of inquiry” (Lipman, 1985), which originates as a scientific or philosophical concept from major American philosophers associated with the pragmatist school developed by Peirce of Dewey, among others (Agostini, 2007). This process serves as a safe environment where children can learn to question, reflect on problems, reason, conceptualize, rationalize their own thoughts, interrogate assumptions, and work with ambiguities (Kennedy, 2010; Matthews & Mullin, 2002; Vansieleghem & Kennedy, 2011). During P4C activities, the educator’s role is to ask open-ended questions to stimulate dialogue and provide a supportive emotional climate for the students to explore different existential issues (Trickey & Topping, 2004). P4C thus provides an environment from which children can learn how to make inferences about their experiences, which is “fundamental to a child’s ability to acquire meaning” (Lipman, 1985). As such, P4C relies on similar principles as existential therapy, which in turn may shed light on the psychological processes that are facilitated by P4C.
P4C and Existential therapy
Existential psychology is a branch of psychology which places emphasis on the phenomenological experience of the individual (Koole, 2010), studies how they come to terms with life’s essential dilemmas and the condition of human existence (Jacobsen, 2008). The existential therapeutic approach focuses on the subjective experience of the individual and their existential anxieties (Koole, 2010). In the form of a therapeutic dialogue, the goal of existential therapy is to enable clients, by emphasizing their strengths and encouraging them to realize their full potential (Jacobsen, 2008). Existential therapy has been developed and empirically supported for adult s only. To our knowledge, it has not been adapted for children and for a larger scale use in school and group settings with youth.
Similar to adults, children strive to allocate meaning to their lives and make sense of the world around them (Demers, Sinclair, & 2015). Although the main focus of P4C is more universal and less centered on the individual (as opposed to the therapy process), themes such as identity, time, being and death are discussed in P4C activities, and are simultaneously main ideas addressed throughout existential therapy (Klein & Westcott, 1994; Koole, 2010). Given the similarity between P4C and existential therapy, it is likely that P4C could have similar positive effects.
Existential therapy also offers information on the psychological processes that could account for its positive effect. In particular, it suggests that increasing people’s awareness of self and autonomy is important in making sense of the world (i.e. meaning making), and, in turn, decreasing psychological distress, psychopathology and increasing overall wellbeing (Classen et al., 2008; Kissane et al., 2007; Vos, Craig, & Cooper, 2015). Indeed, P4C is thought to provide a dialogued environment in which children are empowered by the responsibility to participate in discussions, become aware and reflect on their own thoughts, priorities and values, which, in turn, is hypothesized to foster greater autonomy and well-being (Biggeri & Santi, 2012). The aim to expand an individual’s awareness of their strengths and potential for growth (Yalom & Bugental, 1997) is also at the core of self-determination theory (SDT) (Deci & Ryan, 2013). This theory offers evidence for the importance of basic psychological need satisfaction, in particular the need for autonomy.
Existential therapy and self-determination theory
SDT is an empirically-based metatheoretical approach to human motivation, development and wellbeing. According to SDT, the satisfaction of people’s innate psychological need for autonomy (a sense of volition and self-endorsement of one’s actions), along with the needs for relatedness (a sense of belonging) and competence (a sense that one has an effective impact on one’s environment) is at the core of optimal development and functioning (Ryan & Deci, 2000). In fact, the need to act volitionally has consistently been positively related to psychological wellbeing and self-esteem in youth and adults alike in a variety of settings, namely in elementary schools (Deci & Ryan, 2008; Niemiec & Ryan, 2009). Decades of research in SDT have shown that higher satisfaction of the three basic psychological needs, and most specifically the need for autonomy, is correlated with high quality motivation, perseverance in school and overall academic success, both in elementary, high school and post-secondary students (Niemiec & Ryan, 2009). Students with higher autonomy also have been shown to feel readier to face the inherent challenges of their academic curriculum, such as, for example, the transition from elementary to high school, while showing increased psychosocial adaptive skills, when compared to their less self-determined counterparts (Koestner & Losier, 2002; Taylor et al., 2014).
As such, interventions that aim to foster greater basic psychological needs satisfaction and decrease mental health issues are of special relevance in school-based settings. However, few published studies have attempted to experimentally manipulate basic psychological need satisfaction, especially in children. The available literature on interventions aimed at increasing need satisfaction has either targeted physical education or overall sports practice with the aim of increasing motivation (Tessier, Sarrazin, & Ntoumanis, 2010) or parenting skills in the context of the home (Joussemet, Mageau, & Koestner, 2014). Results from this literature shows that when teachers or parents are trained to be more autonomy-supportive, children report higher basic psychological need satisfaction and overall wellbeing. Yet, authors have suggested that in regular school settings, P4C could foster greater basic psychological needs satisfaction in children (Malboeuf-Hurtubise, Lefrançois, & Taylor, 2018). This being said, in regular school settings, the available research on basic psychological need satisfaction interventions remains scarce.
Present study
The goal of the present study was thus to evaluate the impact of a P4C intervention, used as an adaptation of existential therapy for children, on positive and negative indicators of mental health in elementary school children. Specifically, the impact of the intervention was evaluated pre-to-post intervention on basic psychological need satisfaction (autonomy, competence and relatedness), positive indicators (life satisfaction and self-esteem) and negative indicators (anxiety and depression symptoms) of mental health. To do so, a randomized cluster trial with a wait-list control group was implemented.
Hypotheses
Based on the available literature on the impact of P4C in children, we hypothesized that the intervention would have a positive impact on both positive and negative indicators of mental health. Specifically, we hypothesized that children from the experimental group would show pre-to-post increases in positive indicators of mental health and decreases in negative indicators of mental health. These improvements would be greater than those observed in children randomly assigned to the wait-list control condition.