15 1 GENERAL INTRODUCTION preventing the onset of disorders in some cases, the overall effectiveness of these programs is generally considered to be small to moderate (Beardslee et al., 2013; Christensen et al., 2010; Fisak et al., 2011; Merry, Hetrick et al., 2012; Mychailyszyn et al., 2012; Rasing et al., 2017; Stockings et al., 2016). Additionally, conventional prevention programs face several social and practical access barriers that hinder the implementation, accessibility, and effectiveness of these programs. First, perceived stigma around mental health can discourage youth from seeking or participating in prevention programs (Clement et al., 2015; Gulliver et al., 2010; Mukolo & Heflinger, 2011; Salloum et al., 2016). Furthermore, access and resources may be limited depending on, for instance, geographical location, socioeconomic status, healthcare and ethnic disparities, and shortage of mental health professionals and long waiting lists (Bijl et al., 2003; Collins et al., 2004; Kataoka et al., 2002; Wells et al., 2001). Additionally, high costs are an important barrier that impedes youth from seeking help, especially those who need it the most (Collins et al., 2004; Salloum et al., 2016). Moreover, limitations and challenges have been identified in the delivery of CBT-based prevention programs. It is important to note that these limitations specifically relate to how CBT is delivered, rather than the underlying therapeutic principles of CBT itself (Granic et al., 2014; Kazdin, 2011). CBT programs largely rely on a didactic approach, which might not be appealing, engaging and motivating for youth (Crenshaw, 2008; De Haan et al., 2013; Weisz & Kazdin, 2010; World Health Organization, 2012). Another limitation in many CBT approaches is the considerable disparity between what youth learn and know, and what they actually do in their daily lives (Eichstedt et al., 2014). Recognising this gap between knowledge and behaviour, CBT programs often incorporate activities such as role-playing, problem-solving exercises, and homework assignments (Kendall, 2011), but these activities are often disconnected from authentic emotional experiences and lack real-life context hampering the transfer of learned skills to other contexts and youths’ everyday lives (Granic et al., 2014). Finally, the aforementioned social barriers (e.g., stigma), practical barriers (e.g., high costs) and the unappealing didactic approach may contribute to the large percentage of premature dropout of mental healthcare that has been reported (De Haan et al., 2013; Salloum et al., 2016). Taken together, these limitations and barriers of conventional prevention programs highlight the need for alternative delivery approaches that are engaging, motivating, accessible, and cost-effective (P. J. Jones et al., 2019; Kazdin, 2019; Liverpool et al., 2020; Weisz et al., 2019).
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