رفتاردرمانی شناختی مبتنی بر کلاس درس (دوستان): یک خوشه آزمایشی برای جلوگیری از اضطراب در کودکان از طریق آموزش در مدارس تصادفی تحت کنترل

Anxiety disorders affect 10% of children by the age of 16 years.1 They significantly impair everyday functioning, often persist into adulthood, and increase the risk of other psychiatric disorders in adolescence and young adulthood.2, 3, 4 and 5 The associated health-related burden, and economic and societal costs are large, and the need to improve the mental health of children is being increasingly recognised as a global priority.6, 7 and 8 Effective psychological interventions, especially cognitive behaviour therapy (CBT), are available for children with anxiety disorders.9 and 10 However, comparatively few children with anxiety disorders are identified and referred for treatment.11 and 12 The poor reach and availability of traditional treatment services has led to interest in more proactive preventive approaches with schools offering a convenient and natural location to deliver such programmes.13 and 14 Findings of systematic reviews show that universal and targeted anxiety prevention programmes are often based on cognitive behaviour therapy.15 Data from reviews15 and 16 suggest that cognitive behaviour therapy prevention programmes can be effective, although research methods are poor, adequately powered implementation trials are scarce, results are inconsistent, and effect sizes vary greatly. Most studies report overall changes in symptoms, and the preventive benefits for less symptomatic participants have seldom been reported. Prevention programmes can be universally provided to all of an identified population, or targeted towards those at risk of developing a disorder or showing early signs of a disorder, or a combination of both approaches.17 Universal programmes have good reach, avoid the need for screening, are less stigmatising, and offer the potential to enhance mental health and reduce present symptoms. Targeted programmes focus scarce resources on individuals with greatest needs, and usually achieve larger treatment effects.18 and 19 The effect of the intervention leader (health vs school professional) has important implications for the method of delivery and sustainability of an intervention but has been directly investigated in only one study. 20 Barrett and Turner noted that a universal anxiety prevention programme (FRIENDS; panel 1) was equally effective in the reduction of symptoms of anxiety in children aged 10–12 years when given by a psychologist or teacher. However, systematic reviews have reached different conclusions about who is most effective at delivering these programmes. 15 and 16 Panel 1. Acronym for the FRIENDS process F Feelings R Remember to relax I I can do it. I can try my best E Explore solutions and coping step plans N Now reward yourself. You've done your best D Don't forget practice S Smile. Stay calm for life Before anxiety prevention programmes can be endorsed and widely provided, independent implementation trials are needed to measure effectiveness and cost-effectiveness when provided under real-life conditions and to establish the effect of the intervention leader on outcome. We undertook a pragmatic assessment of the effectiveness of a classroom-based anxiety prevention programme (FRIENDS21) universally delivered by health and school professionals to school years 4 and 5 (children aged 9–10 years) in UK junior schools.

Anxiety disorders affect 10% of children by the age of 16 years.1 They significantly impair everyday functioning, often persist into adulthood, and increase the risk of other psychiatric disorders in adolescence and young adulthood.2, 3, 4 and 5 The associated health-related burden, and economic and societal costs are large, and the need to improve the mental health of children is being increasingly recognised as a global priority.6, 7 and 8 Effective psychological interventions, especially cognitive behaviour therapy (CBT), are available for children with anxiety disorders.9 and 10 However, comparatively few children with anxiety disorders are identified and referred for treatment.11 and 12 The poor reach and availability of traditional treatment services has led to interest in more proactive preventive approaches with schools offering a convenient and natural location to deliver such programmes.13 and 14 Findings of systematic reviews show that universal and targeted anxiety prevention programmes are often based on cognitive behaviour therapy.15 Data from reviews15 and 16 suggest that cognitive behaviour therapy prevention programmes can be effective, although research methods are poor, adequately powered implementation trials are scarce, results are inconsistent, and effect sizes vary greatly. Most studies report overall changes in symptoms, and the preventive benefits for less symptomatic participants have seldom been reported. Prevention programmes can be universally provided to all of an identified population, or targeted towards those at risk of developing a disorder or showing early signs of a disorder, or a combination of both approaches.17 Universal programmes have good reach, avoid the need for screening, are less stigmatising, and offer the potential to enhance mental health and reduce present symptoms. Targeted programmes focus scarce resources on individuals with greatest needs, and usually achieve larger treatment effects.18 and 19 The effect of the intervention leader (health vs school professional) has important implications for the method of delivery and sustainability of an intervention but has been directly investigated in only one study. 20 Barrett and Turner noted that a universal anxiety prevention programme (FRIENDS; panel 1) was equally effective in the reduction of symptoms of anxiety in children aged 10–12 years when given by a psychologist or teacher. However, systematic reviews have reached different conclusions about who is most effective at delivering these programmes. 15 and 16 Panel 1. Acronym for the FRIENDS process F Feelings R Remember to relax I I can do it. I can try my best E Explore solutions and coping step plans N Now reward yourself. You've done your best D Don't forget practice S Smile. Stay calm for life Before anxiety prevention programmes can be endorsed and widely provided, independent implementation trials are needed to measure effectiveness and cost-effectiveness when provided under real-life conditions and to establish the effect of the intervention leader on outcome. We undertook a pragmatic assessment of the effectiveness of a classroom-based anxiety prevention programme (FRIENDS21) universally delivered by health and school professionals to school years 4 and 5 (children aged 9–10 years) in UK junior schools.

Findings 45 schools were enrolled: 14 (n=497 children) were randomly assigned to school-led FRIENDS, 14 (n=509) to health-led FRIENDS, and 12 (n=442) to usual school provision. 1257 (92%) children completed 12 month assessments (449 in health-led FRIENDS, 436 in school-led FRIENDS, and 372 in usual school provision). We recorded a difference at 12 months in adjusted mean child-reported RCADS scores for health-led versus school-led FRIENDS (19·49 [SD 14·81] vs 22·86 [15·24]; adjusted difference −3·91, 95% CI −6·48 to −1·35; p=0·0004) and health-led FRIENDS versus usual school provision (19·49 [14·81] vs 22·48 [15·74]; −2·66, −5·22 to −0·09; p=0·043). We noted no differences in parent or teacher ratings. Training teachers to deliver mental health programmes was not as effective as delivery by health professionals.