A seven-week school programme combining emotional coping skills with physical activity proved practical to deliver to 85 adolescents in four Western Cape schools, according to newly published South African research. The findings suggest a possible model for delivering structured support to learners without depending exclusively on specialist mental health professionals.
The programme, called #FeelThinkMove, was evaluated in a single-arm feasibility study published in Pilot and Feasibility Studies on 6 October 2026. It involved young people aged 15 to 18 who were considered at risk of mental health difficulties. The participants were not a representative sample of South African adolescents.
Researchers reported that 84% of participants completed the programme, while acceptability reached 94%. Facilitator competency was rated at 96%, and content fidelity at 86%. These are indicators of practical delivery and reception, not direct evidence that the programme prevented or cured depression.
The team also recorded improvements in self-reported mental health outcomes after the sessions. However, the research did not include a randomly assigned comparison group. That means the observed changes cannot confidently be attributed to the intervention rather than other influences affecting learners during the study.
Why a school-based approach matters
Adolescence can bring intense emotional and social pressures that affect learning, relationships and wellbeing. Schools may be among the most accessible places to offer preventive support, especially when families face barriers to specialist care. Yet programmes must fit timetables, available facilities and the skills of school-based staff.
Emotion regulation refers to the ways people recognise, interpret and respond to difficult feelings. Physical activity can complement coping strategies by offering opportunities for movement, social participation and routine. Combining these elements is plausible, but plausibility alone does not establish that an intervention improves clinical outcomes.
The programme was adapted to the South African context rather than copied without modification from another setting. Cultural relevance, delivery language, school resources and the circumstances of participating families all influence whether a structured intervention is practical. These implementation questions were central to the research.
How the study was organised
The researchers enrolled 85 adolescents in eight groups across four Western Cape schools. The intervention was delivered weekly over seven weeks. Investigators examined attendance, programme completion, acceptability, facilitator competency and whether sessions followed the planned content.
Participants completed questionnaires before the intervention, about one week after it ended and again three months later. The assessments included measures relevant to depression, anxiety, post-traumatic stress symptoms, emotion regulation, self-esteem and physical activity. Repeated measurement made it possible to describe changes over time.
The design was deliberately focused on feasibility. Every participant was offered the programme, and no group was randomly allocated to continue with usual school support alone. Consequently, the study is more informative about implementation than about how much benefit the intervention adds compared with existing services.
The intervention used a task-sharing approach in which trained facilitators could deliver structured activities. This matters in settings where access to specialist clinicians is limited. However, a task-sharing model still requires supervision, clear safeguarding procedures and reliable pathways to refer learners needing more intensive care.
The key implementation results
Survey completion was 100% at baseline, 99% at the eight-week assessment and 95% at the three-month assessment. These rates suggest that researchers were able to maintain contact with nearly all participants, including after the seven-week intervention ended. Follow-up retention is particularly important when designing a larger trial.
Programme completion reached 84%, a separate outcome from questionnaire completion. A learner might respond to follow-up questions without attending enough sessions to be considered a programme completer. Treating those percentages as distinct avoids confusing strong research follow-up with perfect attendance.
Acceptability reached 94%, indicating that participants generally responded positively to the programme. Facilitator competency was reported at 96%, while fidelity to planned content was 86%. These results address different questions: whether learners accepted the sessions, whether facilitators demonstrated relevant skills and whether activities were delivered as designed.
Strong acceptability cannot substitute for evidence of therapeutic effectiveness. A popular programme may fail to improve symptoms, while an effective intervention can struggle with attendance. The value of these findings is that several practical indicators were favourable at the same time, supporting the case for further evaluation.
What happened to mental health measures
Secondary analyses found reductions in reported depression, anxiety, post-traumatic stress symptoms and difficulties regulating emotions at follow-up assessments. The researchers also reported increases in self-esteem and physical activity at the eight-week assessment. These observations are encouraging but should be interpreted cautiously.
Because there was no control group, it is impossible to determine how much of the observed change would have occurred without the programme. Learners’ symptoms can vary with school demands, family circumstances, the passage of time or other support. Statistical change within one group is not the same as a causal intervention effect.
The published summary does not establish that every participant experienced a clinically meaningful improvement. An average change across a small sample may conceal substantial differences between individuals. A larger trial should examine both average outcomes and the proportion of learners experiencing meaningful benefits or deterioration.
The researchers themselves described the results as showing preliminary therapeutic potential and called for a randomised controlled trial. That is the appropriate interpretation: the programme appears deliverable and potentially helpful, but its effectiveness remains unproven.
Why the three-month assessment matters
The 95% survey completion rate at three months is useful because longer follow-up is often difficult in school research. Keeping participants engaged with assessments helps reduce uncertainty caused by missing information. It also suggests that more ambitious follow-up may be achievable in a future study.
However, retaining participants is not the same as demonstrating sustained mental health improvement. The design cannot separate changes associated with the intervention from other events occurring during the follow-up period. A comparison group would make the longer-term findings more interpretable.
Future researchers could examine how learners use coping strategies during examinations, changes in school routines and stressful family circumstances. Longer follow-up could also establish whether improvements, if causally demonstrated, persist after facilitators stop meeting with participants.
Implications for schools and policymakers
For school leaders, the immediate lesson concerns implementation. The study shows that a structured sequence of emotional coping and movement sessions can be organised in participating Western Cape schools, with high follow-up rates and favourable ratings of delivery. That could inform training plans and school timetables.
It would be premature to assume the same completion and acceptability rates across all South African provinces. The sample came from four schools, and learners were selected because they were considered at risk. Different languages, school resources, staff workloads and community circumstances could alter delivery substantially.
Scaling would also require costing the programme. Facilitator training, supervision, materials, safeguarding and monitoring all have resource implications. High-quality delivery during a supported research project does not guarantee that the same standards can be sustained in routine school operations.
Group-based preventive support must also be integrated with referral pathways for learners with serious symptoms or immediate safety concerns. School programmes can complement professional care, but they should not be represented as substitutes for diagnosis, treatment or crisis services.
Important limitations
The central limitation is the absence of random assignment and a comparison group. That does not undermine the study’s stated feasibility objective, but it sharply limits conclusions about effectiveness. Improvements in questionnaires should not be described as proof that #FeelThinkMove caused better mental health.
The sample of 85 was relatively small and concentrated in one province. Participants were older adolescents considered at risk, so the findings cannot automatically be generalised to younger children, all learners or schools in very different circumstances.
Self-reported outcomes can also be influenced by participants’ expectations and willingness to provide favourable responses. A larger trial could strengthen the evidence through prespecified outcomes, independent assessment where practical and clearer comparisons with usual support.
The feasibility study was registered retrospectively in the Pan African Clinical Trial Registry in December 2024. Advance registration is generally preferable because it helps distinguish planned analyses from decisions made after observing the data. This is relevant context for interpreting secondary outcomes.
The research was supported by the Sue Struengmann Initiative, with publication funding from Carnegie Corporation of New York. The authors reported no competing interests. Funding and disclosure details should be considered transparently alongside the study design and findings.
What should happen next
A properly powered randomised controlled trial could compare #FeelThinkMove with usual school support or another credible intervention. Researchers could then estimate whether changes in depression, anxiety, emotion regulation and physical activity exceed the changes observed in comparable learners who did not receive the programme.
Such a trial should assess how consistently the intervention is delivered across different schools, whether its effects persist and what it costs per learner. It could also explore which elements are most useful and whether combining physical activity with emotional coping skills offers added value.
For now, the strongest conclusion is practical rather than clinical. Among 85 participating Western Cape adolescents, the programme achieved favourable completion, acceptability and delivery indicators. That is a useful foundation for more rigorous research, but not yet evidence for a nationwide rollout.
Source Information
Study title: The #FeelThinkMove programme: feasibility and acceptability of an emotion regulation and physical activity intervention for older adolescents in South Africa.
Authors: C. Ward-Smith, K. Sorsdahl, M. Berking and C. van der Westhuizen.
Journal: Pilot and Feasibility Studies, Springer Nature.
Publication date: 6 October 2026.
Study design: Single-arm school-based feasibility study with baseline, eight-week and three-month assessments.
Sample: 85 adolescents aged 15 to 18 in eight groups across four Western Cape schools.
Original study DOI: 10.1186/s40814-026-01920-9.
Funding: Sue Struengmann Initiative; publication grant from Carnegie Corporation of New York.
Trial registration: PACTR202412659160564, retrospectively registered 17 December 2024.
