Promoting well-being
ANXIETY PREVENTION PROGRAMMES
The results of school-based anxiety prevention
programmes are more consistent and encouraging.
A recent review [14] identified 27 trials assess-
ing 20 different programmes; 16 universal, eight
indicated and three selective trials were evaluated.
The majority (78%) were based upon CBT inter-
ventions that were mainly led by mental health
practitioners (44%) or teachers (26%). Only four
studies included children under the age of 9 years.
Seventy-eight percent of interventions reported
significant post-intervention reductions in symp-
toms of anxiety, with universal and targeted pro-
grammes being judged equally effective. There
was considerable variability in effectiveness within
individual programmes. Unlike depression preven-
tion interventions, teacher-led anxiety prevention
interventions were equally as effective as those led
by mental health professionals. The authors sug-
gest encouraging the widespread implementation
of school-based anxiety prevention programmes,
alongside rigorous evaluation of their longer-term
outcomes.
‘FRIENDS for life’ is one of the better evaluated
anxiety prevention programmes. The 10-session
programme is based upon CBT and has versions
for children (aged 7–11), youths (12–16) and more
recently for young children aged 4– 6 years (Fun
FRIENDS). The programme is very engaging and
involves a mix of large and small group work, role
plays, games, activities and quizzes, and teaches
children skills in three main areas. Cognitively,
children are helped to become aware of their
anxiety-increasing cognitions and to replace them
with more helpful and balanced cognitions. Emo-
tionally, they are helped to understand the anxiety
response and their unique physiological reaction
to stressful situations. This helps children to detect
early signs of anxiety so that they can intervene to
manage and reduce these unpleasant feelings. The
final component addresses the behavioural domain
and teaches children problem-solving skills and
the use of graded exposure to systematically face
and overcome their worries. FRIENDS can be led
by trained teachers or mental health practitioners
such as school nurses or psychology graduates.
In addition to the child sessions, parents are
invited to two to four psycho-educational ses-
sions. These help parents to understand anxiety
and to develop strategies to cope with their own
anxiety. They are also taught problem-solving and
the principles of contingency management and
reinforcement in which the child’s courageous and
coping behaviour is rewarded rather than their
anxious talk and problem avoidance.
Randomized controlled trials have demon-
strated significant post-‘FRIENDS’ reductions
in anxiety, which have been maintained up to
3 years after the intervention [15,16]. Similarly,
the issue of effectiveness when delivered within
everyday settings has been assessed in a series of
small studies, with gains being present for up to 12
months [17,18].
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