Cognitive Behavioral Therapy in the School Setting

Abstract

This paper is a review of the literature surrounding schools implementing cognitive behavioral therapies (CBT) for students with anxiety disorders. Being able to better understand and work with students who may be showing signs of anxiety or have been diagnosed with anxiety issues is crucial in allowing academic success. Several evidence-based researches are presented and identified as having positive results with their students in a school setting.

Keywords: cognitive therapy, behavior therapy, anxiety, experience, schools, clinical setting, universal intervention, selective program, indicated program

Cognitive Behavior and Students with Anxiety Disorders

Many of the children in our schools today are experiencing more and more anxiety and sadly, many are going unnoticed.

Many teachers will have classes that will have a unique combination of student personalities and learning abilities. Inclusive classrooms will contain a mixture of students with mental health disorders. Anxiety is a multidimensional construct featuring symptoms of physiological, cognitive, and emotional stress (Robleck & Piacentini, 2005). Anxiety has recently been identified as one of the most prevalent mental health problems affecting children and adolescence today.

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Most teachers do not recognize anxiety disorders as these students are generally rule followers and do not like to draw attention to themselves.

The Need for School Improvement

Given school’s direct access to affected children and the impact anxiety disorders have on student’s functioning, schools may be the ideal setting to deliver CBT programs for child anxiety. About 6% to 11% of school-aged children meet diagnostic criteria for anxiety disorder at any given time (Briggs-Gowan, Horwitz, Schwab-Stone, Leventhal, & Leaf, 2000).

Anxious youth experience difficulties in social (e.g. limited or unrewarding social networks), familial (e.g. sibling/parental conflict, accommodation around anxiety), and academic (e.g. poor performance, school refusal, limited extracurricular activities; Kendall et al., 2003; Van Ameringen, Mancini & Farvolden, 2003; Woodward & Fergusson, 2001) domains. Also, schools offer relatively convenient and inexpensive services, barriers to accessing specialty care, such as financial and transportation difficulities (Catron, Harris, Weiss, 1998).

Support for CBT with Anxious Youth in School Based Setting

Three types of school-based intervention protocols have been examined regarding cognitive behavioral interventions in student populations. First, Universal intervention programs which provide preventive treatment for all students in the school or classroom regardless of each individual student’s level of anxiety or impairment. This proactive and preventive approach is more efficient and cost effective in the long run than reactive approaches which wait for youth to develop clinical-level disorders (Weissman, Antinoro & Chu, 2008). However, this approach comes with sacrifices such as individual student attention and required dedication of time and resources, potentially taking away from other academic and extracurricular activities (Weissman, Antinorno & Chu, 2008). Second, selective programs target adolescents who are already identified as at-risk (Neil and Christenses, 2009). Thirdly, indicated programs target adolescents already showing low-to-moderate symptoms, and therefore being at high risk to develop disorders (Neil and Christenses, 2009).

Use of Universal Intervention of CBT in the Schools

There have been numerous attempts to bring CBT programs to schools providing their effectiveness other than in mental health clinics. Schools were initially concerned about loss of academic time, building space and scheduling.

Masia and colleagues (2001) developed and tested:

Skills for Academic and Social Success (Fisher et aI., 2004; Masia et aI., 2001; Masia-Warner et aI., 2005), an indicated school-based intervention targeting social deficits in socially anxious high school adolescents. It was anecdotally labeled acceptable by professionals in the natural school environment, and program administrators received positive responses (e.g., commentaries, notes, requests for the program the following year) from family members and school personnel.

The results were overwhelming and indicated that 50% of the students were social anxiety free at posttreatment (Masia et aI., 2001). In the follow-up randomized controlled trial, the treatment group demonstrated a 67% rate of remission from their primary social anxiety diagnosis at posttreatment compared to only 6% of the wait-list control group (Masia-Warner et al., 2005). Because schools are a prime source for peer contact and real-life exposure tasks, it is encouraging that both parents and school personnel deemed the intervention suitable for implementation during the regular school day.