School-based cognitive behavioral interventions for anxious youth: study protocol for a randomized controlled trial

Bente Storm Mowatt Haugland, Solfrid Raknes, Aashild Tellefsen Haaland, Gro Janne Wergeland, Jon Fauskanger Bjaastad, Valborg Baste, Joe Himle, Ron Rapee, Asle Hoffart, Bente Storm Mowatt Haugland, Solfrid Raknes, Aashild Tellefsen Haaland, Gro Janne Wergeland, Jon Fauskanger Bjaastad, Valborg Baste, Joe Himle, Ron Rapee, Asle Hoffart

Abstract

Background: Anxiety disorders are prevalent among adolescents and may have long-lasting negative consequences for the individual, the family and society. Cognitive behavioral therapy (CBT) is an effective treatment. However, many anxious youth do not seek treatment. Low-intensity CBT in schools may improve access to evidence-based services. We aim to investigate the efficacy of two CBT youth anxiety programs with different intensities (i.e., number and length of sessions), both group-based and administered as early interventions in a school setting. The objectives of the study are to examine the effects of school-based interventions for youth anxiety and to determine whether a less intensive intervention is non-inferior to a more intensive intervention.

Methods/design: The present study is a randomized controlled trial comparing two CBT interventions to a waitlist control group. A total of 18 schools participate and we aim to recruit 323 adolescents (12-16 years). Youth who score above a cutoff on an anxiety symptom scale will be included in the study. School nurses recruit participants and deliver the interventions, with mental health workers as co-therapists and/or supervisors. Primary outcomes are level of anxiety symptoms and anxiety-related functional impairments. Secondary outcomes are level of depressive symptoms, quality of life and general psychosocial functioning. Non-inferiority between the two active interventions will be declared if a difference of 1.4 or less is found on the anxiety symptom measure post-intervention and a difference of 0.8 on the interference scale. Effects will be analyzed by mixed effect models, applying an intention to treat procedure.

Discussion: The present study extends previous research by comparing two programs with different intensity. A brief intervention, if effective, could more easily be subject to large-scale implementation in school health services.

Trial registration: ClinicalTrials.gov, NCT02279251 . Registered on 15 October 2014. Retrospectively registered.

Keywords: adolescents; anxiety; low-intensity CBT; school-based.

Figures

Fig. 1
Fig. 1
Flow chart of the study

References

    1. Essau CA, Conradt J, Peterman F. Course and outcome of anxiety disorders in adolescents. J Anxiety Disord. 2002;16:67–81. doi: 10.1016/S0887-6185(01)00091-3.
    1. Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005;62(6):593–602. doi: 10.1001/archpsyc.62.6.593.
    1. Bodden DH, Dirksen CD, Bogels SM. Societal burden of clinically anxious youth referred for treatment: a cost-of-illness study. J Abnorm Child Psychol. 2008;36(4):487–97. doi: 10.1007/s10802-007-9194-4.
    1. Costello EJ, Mustillo S, Erkanli A, Keeler G, Angold A. Prevalence and development of psychiatric disorders in childhood and adolescence. Arch Gen Psychiatry. 2003;60(8):837–44. doi: 10.1001/archpsyc.60.8.837.
    1. Mykletun A, Overland S, Dahl AA, Krokstad S, Bjerkeset O, Glozier N, Aaro LE, Prince M. A population-based cohort study of the effect of common mental disorders on disability pension awards. Am J Psychiatry. 2006;163:1412–8.
    1. Baxter AJ, Vos T, Scott KM, Ferrari AJ, Whiteford HA. The global burden of anxiety disorders in 2010. Psychol Med. 2014;44:2363–74. doi: 10.1017/S0033291713003243.
    1. Mychailyszyn MP, Mendez JL, Kendall PC. School functioning in youth with and without anxiety disorders: comparisons by diagnosis and comorbidity. Sch Psychol Rev. 2010;39(1):106–21.
    1. Peterman JS, Carper MM, Elkins RM, Comer JS, Pincus DB, Kendall PC. The effects of cognitive-behavioral therapy for youth anxiety on sleep problems. J Anxiety Disord. 2016;37:78–88. doi: 10.1016/j.janxdis.2015.11.006.
    1. Van Ameringena M, Mancinia C, Farvolden P. The impact of anxiety disorders on educational achievement. J Anxiety Disord. 2003;17(5):561–71. doi: 10.1016/S0887-6185(02)00228-1.
    1. Rao PA, Beidel DC, Turner SM, Ammerman RT, Crosby LE, Sallee FR. Social anxiety disorder in childhood and adolescence: descriptive psychopathology. Behav Res Ther. 2007;45(6):1181–91. doi: 10.1016/j.brat.2006.07.015.
    1. Verduin TL, Kendall PC. Peer perceptions and liking of children with anxiety disorders. J Abnorm Child Psychol. 2008;36(4):459–69. doi: 10.1007/s10802-007-9192-6.
    1. Wolk CB, Kendall PC, Beidas RS. Cognitive-behavioral therapy for child anxiety confers long-term protection from suicidality. J Am Acad Child Adolesc Psychiatry. 2015;54(3):175–9. doi: 10.1016/j.jaac.2014.12.004.
    1. Wittchen H-U, Beesdo K, Bittner A, Goodwin RD. Depressive episodes–evidence for a causal role of primary anxiety disorders? Eur Psychiatry. 2003;18:384–93. doi: 10.1016/j.eurpsy.2003.10.001.
    1. Puleo CM, Conner BT, Benjamin BL, Kendall PC. CBT for childhood anxiety and substance use at 7.4-year follow-up: a reassessment controlling for known predictors. J Anxiety Disord. 2011;25:690–6. doi: 10.1016/j.janxdis.2011.03.005.
    1. James AC, James G, Cowdrey FA, Soler A, Choke A. Cognitive behavioural therapy for anxiety disorders in children and adolescents. Cochrane Library. 2013;(6). doi:10.1002/14651858.CD00460.pub4.
    1. Rapee RM, Schniering CA, Hudson JL. Anxiety disorders during childhood and adolescence: origins and treatment. Annu Rev Clin Psychol. 2009;5:311–41. doi: 10.1146/annurev.clinpsy.032408.153628.
    1. Higa-McMillan CK, Francis SE, Rith-Najarian L, Chorpita BF. Evidence base update: 50 years of research on treatment for child and adolescent anxiety. J Clin Child Adolesc. 2016;45(2):91–113. doi: 10.1080/15374416.2015.1046177.
    1. Heiervang E, Stormark KM, Lundervold AJ, Heimann M, Goodman R, Posserud M, Ullebø AK, Plessen KJ, Bjelland I, Lie SA, Gillberg C. Psychiatric disorders in Norwegian 8- to 10-year-olds: an epidemiological survey of prevalence, risk factors, and service use. J Am Acad Child Psy. 2007;46:438–47.
    1. Chavira DA, Stein MB, Bailey K, Stein MT. Child anxiety in primary care: Prevalent but untreated. Depress Anxiety. 2004;20:155–64. doi: 10.1002/da.20039.
    1. Thompson A, Issakidis C, Hunt C. Delay to seek treatment for anxiety and mood disorders in an Australian clinical sample. Behav Change. 2008;25:71–84. doi: 10.1375/bech.25.2.71.
    1. WHO. Atlas: child and adolescent mental health resources: global concerns, implications for the future. Barriers to Care. . 2005. Accessed 08 Jul, 2016. Report No.
    1. Salloum A, Johnco C, Lewin AB, McBride NM, Storch AA. Barriers to access and participation in community mental health treatment for anxious children. J Affect Disord. 2016;196:54–61. doi: 10.1016/j.jad.2016.02.026.
    1. Bennett-Levy J, Richards D, Farrand P, Christensen H, Griffiths K, Kavanagh D, Klein B, Lau MA, Proudfoot J, Ritterband L, White J, Williams C. Oxford Guide to Low Intensity CBT Interventions. New York: Oxford University Press; 2010.
    1. Mychilyszyn MP, Beidas RS, Benjamin CL, Edmunds JM, Podell JL, Cohen JS, Kendall PC. Assessing and treating child anxiety in schools. Psychol Schools. 2011;48(3):223–232.
    1. O’Brien D, Harvey K, Howse J, Reardon T, Creswell C. Barriers to managing child and adolescent mental health problems: a systematic review of primary care practitioners’ perceptions. Br J Gen Pract. 2016:1–15. doi:10.3399/bjp16X687061.
    1. Teubert D, Pinquart M. A meta-analytic review on the prevention of symptoms of anxiety in children and adolescents. J Anxiety Disord. 2011;25:1046–59. doi: 10.1016/j.janxdis.2011.07.001.
    1. Fisak BJ, Richard D, Mann A. The prevention of child and adolescent anxiety: a meta-analytic review. Prev Sci. 2011;12:255–68. doi: 10.1007/s11121-011-0210-0.
    1. Neil AL, Christensen H. Efficacy and effectiveness of school-based prevention and early intervention programs for anxiety. Clin Psychol Rev. 2009;29:208–15. doi: 10.1016/j.cpr.2009.01.002.
    1. McLoone JK, Rapee RM. Comparison of an anxiety management program for children implemented at home and school: lessons learned. Sch Ment Heal. 2012;4:231–42. doi: 10.1007/s12310-012-9088-7.
    1. Miller LD, Laye-Gindhu A, Liu Y, March JS, Thordarson DS, Garland EJ. Evaluation of a preventive intervention for child anxiety in two randomized attention-control school trials. Behav Res Ther. 2011;49:315–23. doi: 10.1016/j.brat.2011.02.006.
    1. Arendt K, Thastum M, Hougaard E. Efficacy of a Danish version of the Cool Kids program: a randomized wait-list controlled trial. Acta Psychiatr Scand. 2015;133:109–121.
    1. Hudson JL, Rapee RM, Deveney C, Schniering CA, Lyneham HJ, Bovopoulos N. Cognitive-behavioral treatment versus an active control for children and adolescents with anxiety disorders: a randomized trial. J Am Acad Child Adolesc Psychiatry. 2009;48(5):533–44. doi: 10.1097/CHI.0b013e31819c2401.
    1. Mifsud C, Rapee RM. Early intervention for childhood anxiety in a school setting: outcomes for an economically disadvantaged population. J Am Acad Child Adolesc Psychiatry. 2005;44(10):996–1004. doi: 10.1097/01.chi.0000173294.13441.87.
    1. Craske MG, Zucker BG. Prevention of anxiety disorders: a model for intervention. Appl Prev Psychol. 2001;10(3):155–75. doi: 10.1016/S0962-1849(01)80012-3.
    1. Barrett PM. Friends for Life—Group Leader’s Manual. 4. Brisbane: Australian Academic Press; 2004.
    1. Spence SH. A measure of anxiety symptoms among children. Behav Res Ther. 1998;26:545–66. doi: 10.1016/S0005-7967(98)00034-5.
    1. Lyneham HJ, Sburlati ES, Abbott MJ, Rapee RM, Hudson JL, Tolin DF, Carlson SE. Psychometric properties of the Child Anxiety Life Interference Scale (CALIS). J Anxiety Disord. 2013;27(7):711–9.
    1. Thorpe KE, Zwarenstein M, Oxman AD, Treweek S, Furberg CD, Altman DG, Tunis S, Bergel E, Harvey I, Magid DJ, Chalkidou K. A pragmatic explanatory continuum indicator summary (PRECIS): a tool to help trial designers. J Clin Epidemiol. 2009;62:464–75.
    1. Raknes S, Haaland AT, Haugland BSM, Wergeland GJ, Bjaastad JF, Rogde AH, Hoffart A. VAAG. Et gruppetilbud for ungdom som vil tørre mer. Bergen: RKBU Vest; 2015.
    1. Raknes S. Psykologisk førstehjelp. Ungdom (Psychological First Aid. Adolescent version) Oslo: Gyldendal Akademisk; 2010.
    1. Haugland BSM, Mauseth T, Raknes S. Psykologisk førstehjelp i førstelinjetjenesten. Implementering og evaluering/Psychological First Aid in primary health services, implementation and evaluation. Oslo: Directory of Health; 2013.
    1. Rapee RM, Lyneham HJ, Schniering CA, Wuthrich V, Abbott MA, Hudson JL, Wignall A. The Cool Kids Child and Adolescent Anxiety Program Therapist Manual (School Version). Centre for Emotional Health. Sydney: Macquarie University; 2006.
    1. Jonsson H, Thastum M, Arendt K, Juul-Sorensen M. Group cognitive behavioural treatment of youth anxiety in community based clinical practice: clinical significance and benchmarking against efficacy. J Anxiety Disord. 2015;35:9–18. doi: 10.1016/j.janxdis.2015.06.009.
    1. Nauta MH, Scholing A, Rapee RM, Abbott M, Spence SH, Waters A. A parent-report measure of children’s anxiety: psychometric properties and comparison with child-report in a clinic and normal sample. Behav Res Ther. 2004;42(7):813–39. doi: 10.1016/S0005-7967(03)00200-6.
    1. Arendt K, Hougaard E, Thastum M. Psychometric properties of the child and parent versions of Spence children’s anxiety scale in a Danish community and clinical sample. J Anxiety Disord. 2014;28(8):947–56. doi: 10.1016/j.janxdis.2014.09.021.
    1. Spence SH, Barrett PM, Turner CM. Psychometric properties of the Spence Children’s Anxiety Scale with young adolescents. J Anxiety Disord. 2003;17:605–25. doi: 10.1016/S0887-6185(02)00236-0.
    1. Angold A, Costello EJ, Messer SC, Pickles A. Development of a short questionnaire for use in epidemiological studies of depression in children and adolescents. Int J Meth Psych Res. 1995;5(4):237–49.
    1. Kuo ES, Vander Stoep A, Stewart DG. Using the Short Mood and Feelings Questionnaire to detect depression in detained adolescents. Assessment. 2005;12(4):374–83. doi: 10.1177/1073191105279984.
    1. Sharp C, Goodyer IM, Croudace TJ. The Short Mood and Feelings Questionnaire (SMFQ): A unidimensional item response theory and categorical data factor analysis of self-report ratings from a community sample of 7-through 11-year-old children. J Abnorm Child Psych. 2006;34(3):379–91.
    1. Guy W. ECDEU Assessment Manual for Psychopharmacology. Rockville: US Department of Health, Education, and Welfare Public Health Service Alcohol, Drug Abuse, and Mental Health Administration; 1976.
    1. Goodman R. The Strengths and Difficulties Questionnaire: a research note. J Child Psychol Psychiatry. 1997;38(5):581–6. doi: 10.1111/j.1469-7610.1997.tb01545.x.
    1. Goodman R, Ford T, Simmons H, Gatward R, Meltze H. Using the Strengths and Difficulties Questionnaire (SDQ) to screen for child psychiatric disorders in a community sample. Br J Psychiatry. 2000;177(6):534–9. doi: 10.1192/bjp.177.6.534.
    1. Muris P, Meesters C, van den Berg F. The Strengths and Difficulties Questionnaire (SDQ) Br J Psychiatry. 2003;12(1):1–8.
    1. Ravens-Sieberer U, Bullinger M. KINDL-R Manual. Questionnaire for Measuring Health-Related Quality of Life in Children and Adolescents Revised Version. 2000.
    1. Helseth S, Lund T, Christophersen K-A. Health-related quality of life in a Norwegian sample of healthy adolescents: some psychometric properties of CHQ-CF87-N in relation to KINDL-N. J Adolesc Health. 2006;38(4):416–25. doi: 10.1016/j.jadohealth.2004.11.136.
    1. Jozefiak T, Reinfjell T. Måleegenskaper ved den norske versjonen av Kinder Lebensqualität Fragebogen (KINDL®). PsykTestBarn. 2012;2(2):1-8.
    1. Hysing M, Haugland S, Stormark KM, Bøe T, Sivertsen B. Sleep and school attendance in adolescence: results from a large population-based study. Scand J Public Health. 2015;43(1):2–9. doi: 10.1177/1403494814556647.
    1. Hysing M, Harvey AG, Linton SJ, Askeland KG, Sivertsen B. Sleep and academic performance in later adolescence: results from a large population-based study. J Sleep Res. 2016;25(3):318–24. doi: 10.1111/jsr.12373.
    1. Schwarzer R, Jerusalem M. Generalized Self-Efficacy scale. In: Weinman J, Wright S, Johnston M, editors. Measures in health psychology: a user’s portfolio. Causal and control beliefs. Windsor: NFER-NELSON; 1995. pp. 35–7.
    1. Schniering CA, Rapee RM. Development and validation of a measure of children’s automatic thoughts: the children’s automatic thoughts scale. Behav Res Ther. 2002;40(9):1091–109. doi: 10.1016/S0005-7967(02)00022-0.
    1. Devilly GJ, Borkovec TD. Psychometric properties of the credibility/expectancy questionnaire. J Behav Ther Exp Psychiatry. 2000;31:73–86. doi: 10.1016/S0005-7916(00)00012-4.
    1. Nordanger DO, Breivik K, Haugland BS, Lehmann S, Maehle M, Braarud HC, Hysing M. Prior adversities predict posttraumatic stress reactions in adolescents following the Oslo Terror events 2011. Eur J Psychotraumatol. 2014;5. PubMed Central PMCID: 4032508.
    1. Hjemdal O, Friborg O, Stiles TC, Martinussen M, Rosenvinge JH. A new scale for adolescent resilience: grasping the central protective resources behind healthy development. Meas Eval Couns Dev. 2006;39(2):84–96.
    1. Lovibond SH, Lovibond PF. Manual for the Depression Anxiety Stress Scales. 2. Sydney: School of Psychology, University of New South Wales; 1995.
    1. Brannan AM, Heflinger CA, Bickman L. The Caregiver Strain Questionnaire: measuring the impact on the family of living with a child with serious emotional disturbance. J Emot Behav Disord. 1997;5(4):212–22. doi: 10.1177/106342669700500404.
    1. Bjaastad JF, Haugland BS, Fjermestad KW, Torsheim T, Havik OE, Heiervang ER, Öst L-G. Competence and Adherence Scale for Cognitive Behavioral Therapy (CAS-CBT) for Anxiety Disorders in Youth: psychometric properties. Psychol Assess. 2016;28(8):908-916.
    1. Wergeland GJ, Fjermestad KW, Marin CE, Haugland BS, Bjaastad JF, Oeding K, Havik OE, Heiervang E. An effectiveness study of individual vs. group cognitive behavioral therapy for anxiety disorders in youth. Behav Res Ther. 2014;57:1–12.

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