The feelings club: randomized controlled evaluation of school-based CBT for anxious or depressive symptoms.
BACKGROUND
Children with anxious or depressive symptoms are at risk of developing internalizing disorders and their attendant morbidity. To prevent these outcomes, school-based cognitive-behavioral therapy (CBT) has been developed, but few studies include active control conditions. We evaluated a preventive CBT program targeting internalizing symptoms relative to an activity contrast condition post-intervention and at 1-year follow-up.


METHODS
One thousand one hundred and thirty-nine children from Grades 3-6 from a diverse sample of schools, were screened with the Multidimensional Anxiety Scale for Children and Children's Depression Inventory. Those with t>60 on either measure were offered participation in a randomized 12-week trial, school-based group CBT versus a structured after-school activity group of equal duration. We explored several therapeutic elements as potential predictors of change.


RESULTS
One hundred and forty-eight children participated (84 boys, 64 girls; 78 CBT, 70 contrast; 57% Caucasian) and 145 completed the program. Self-reported anxious and depressive symptoms decreased significantly over time (η(2)=.15 and .133, respectively), with no group by time interaction. There was a trend toward fewer children meeting diagnostic criteria for an anxiety disorder on the Anxiety Disorders Interview Schedule at 1-year post-CBT than post-contrast (6/76 versus 12/69). Positive reinforcement of child behavior was associated with change in anxiety symptoms; checking homework was understood with change in depressive symptoms.


CONCLUSIONS
Findings suggest that children with internalizing symptoms may benefit from both school-based CBT and structured activity programs. Replication, longer follow-up, and further studies of therapeutic elements in child CBT are indicated. ISRCTN Registry identifier: ISRCTN88858028, url: http://www.controlled-trials.com/.
Manassis
Katharina
K
Centre for Addiction and Mental Health, Department of Psychiatry, University of Toronto, Canada. katharina.manassis@sickkids.ca
Wilansky-Traynor
Pamela
P
Farzan
Nas
N
Kleiman
Valery
V
Parker
Kevin
K
Sanford
Mark
M
D001007:Anxiety / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D001008:Anxiety Disorders / Q000517:prevention & control; D002170:Canada; D002648:Child; D002652:Child Behavior; D015928:Cognitive Behavioral Therapy; D003863:Depression / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D003866:Depressive Disorder / Q000517:prevention & control; D004644:Emotions; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D010043:Outcome and Process Assessment, Health Care; D011569:Psychiatric Status Rating Scales; D011615:Psychotherapy, Group; D012574:Schools