Effect of the Reassured Self-Compassion–Based School Program on Anxiety, Video Game Addiction, and Body Image Among Rural Female Adolescents: Retrospective Study
Authors: Zuair Areeg 
Published: February 2025

Background
The COVID-19 pandemic has amplified mental health challenges among adolescents, particularly in rural areas with limited access to services. In response, the Saudi government launched mental health campaigns and mandated schools to implement mental health programs. However, the effectiveness of these programs remains largely unreported.

Objective
This study aims to determine the prevalence of anxiety disorder symptoms, video game addiction, and body image dissatisfaction, as well as to examine the effect of a school-based program, The Reassured Self, grounded in compassion-focused therapy, on anxiety symptoms, video game addiction, and body image dissatisfaction among rural adolescent females in Saudi Arabia.

Methods
A retrospective secondary analysis of pre-post intervention data was used. All female middle school students (N=133; age: mean 13.7, SD 1.01 years) in grades 1-3 from a rural setting were included, with no exclusion criteria. Participants were recruited as part of a school-mandated mental health program. Data were collected at baseline (2 weeks before the intervention) and 2-3 weeks post intervention during school hours in a quiet classroom setting using teacher-supervised, printed surveys. Survey completion was voluntary, and students exhibiting high distress based on post data analysis were referred to the school health counselor for support. The intervention consisted of 3 sessions (30-35 minutes each) delivered over 2 weeks. Validated Arabic versions of the Spence Children's Anxiety Scale, Game Addiction Scale, and Body Image Discrepancy Assessment were used to measure outcomes 2 weeks post intervention (April to June 2024). Data were analyzed using linear mixed-effects regression models. Data were analyzed using linear mixed effects regression models.

Results
Among the students, 25.8% (32/124) were identified as having high anxiety levels, with 19.3% (24/124) falling into the clinical concern or very high clinical concern categories. Additionally, 26% (32/123) were classified as problem gamers, while 14% (18/123) were categorized as addicted gamers. A smaller proportion, 5.1% (6/117), expressed a strong desire for thinness. Compared to pre-intervention levels, students exhibited significant reductions in anxiety symptoms (mean difference –4.11, 95% CI –6.98 to –1.24; P=.005) and video game addiction (mean difference –1.62, 95% CI –2.83 to –0.42; P=.009) following the program. However, changes in body image dissatisfaction were minimal and not statistically significant (mean difference 0.067, 95% CI –0.046 to 0.18; P=.057). High satisfaction scores, with a mean of 28.49 out of 35 (SD 6.31), indicated strong acceptability and cultural alignment of the intervention. High satisfaction scores indicated strong acceptability and cultural alignment with the intervention.

Conclusions
The results highlight the potential for compassion-focused school programs to address mental health disparities in underserved adolescent populations. Future research should explore the long-term effects and scalability of such culturally adapted interventions.