An Effectiveness Study of a Culturally Enriched School-Based CBT Anxiety Prevention Program

Abstract

Anxiety disorders are prevalent in the school-aged population and are present across cultural groups. Scant research exists on culturally relevant prevention and intervention programs for mental health problems in the Aboriginal populations. An established cognitive behavioral program, FRIENDS for Life, was enriched to include content that was culturally relevant to Aboriginal students. Students (N = 533), including 192 students of Aboriginal background, participated in the cluster randomized control study. Data were collected three times over 1 year. A series of multilevel models were conducted to examine the effect of the culturally enriched FRIENDS program on anxiety. These analyses revealed that the FRIENDS program did not effectively reduce anxiety for the total sample or for Aboriginal children specifically. However, all students, regardless of intervention condition, Aboriginal status, or gender, reported a consistent decrease in feelings of anxiety over the 6-month study period.

A Personalized and Control Systems Engineering Conceptual Approach to Target Childhood Anxiety in the Contexts of Cultural Diversity

“…As noted, these null findings were likely related to a lack of a clearly delineated control group and longer follow-up, with the latter possibly allowing more time to practice and develop the anxiety coping skills taught. Similar null findings were reported by Miller et al (2011) who randomized 533 children (including many Aboriginal children residing in Canada) to the intervention (FRIENDS culturally adapted) ( n = 269) or a waitlist ( n = 264). Findings showed that no statistically significant reductions in anxiety levels could be attributed to the intervention.…”

“…To secure culturally responsive child anxiety interventions, some degree of cultural adaptation seems necessary based on findings from Cooley et al (2004), Cooley-Strickland et al (2011), Huey and colleagues (2006, 2011), Griner and Smith (2006), Miller et al (2011) and Pina et al (2003; 2012). Research to date offers some sense about what might (or not) work.…”

“…In addition, Huey and Polo concluded that the evidence was equivocal with regard to the need for cultural adaptations (p. 284 and 289) with meta-analyses highlighting a significant number of major concerns with the current status of the field (some of which also have been noted by others: Griner & Smith, 2006; Benish, Quintana, & Wampold, 2011; Ortiz & Del Veccio, 2013). Turning to anxiety prevention, data show that some children are benefiting significantly less from prevention efforts (e.g., Barrett, Sonderegger, & Xenos, 2003; Cooley-Strickland, Griffin, Darney, Otte, & Ko, 2011; Miller et al, 2011). In Barrett et al (2003), 320 immigrant children residing in Australia (6–19 years old; 153 girls; 125 Yugoslavian, 148 Chinese, 47 multi-ethnic) were randomized to an anxiety prevention program (FRIENDS not culturally tailored) ( n = 166) or waitlist ( n = 154).…”

School-based interventions for depression and anxiety in children and adolescents

“…A further factor which is emerging as important in implementation studies is the compatibility of prevention programmes with the school culture and competing priorities. How they practically fit within a complex and full timetable have been identified as major obstacles that can impede effective delivery 10 11 14 16…”

“…For example, in an implementation trial in Canada 63 school staff were trained to deliver FRIENDS to 533 students aged 10–12 attending 15 schools 14. Although treatment fidelity was high and children rated their understanding of the programme as good FRIENDS did not have a significant effect on anxiety for either native or aboriginal students at 6 months.…”