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Effectiveness of Group-Based Acceptance and Commitment Therapy in a School Setting for Children with Anxiety: A Quasi-Randomized Study

Karen Hancock, Anoushka Houseman, Angela Dixon, Cassandra Hainsworth, Lauren Luthra, Jeanette Mansour, Natasha Samy

Background: The aim of the ProACTive in schools study was to investigate the effectiveness of an Acceptance and Commitment Therapy (ACT) group anxiety management program in a school setting in Sydney, Australia.

Methods: Following feasibility and acceptability study, the program was conducted and evaluated using quasi-randomization in 14 schools with group size ranging from 6-8 students with anxiety symptoms. There was no bias in allocation to groups, being pragmatic randomization in a “real-life” setting. Of the 98 students randomly allocated, 57 students comprised the treatment group and 41 the control group. There were 53 completer participants in the treatment group and 37 in a wait-list control group. Participants in the treatment group and their parents/guardian completed some standardized questionnaires (the Spence Child Anxiety Scale, the Child Anxiety Interference Scale) prior to, immediately after and 6 months after participating in the program. These questionnaires assessed students' level of anxiety and quality of life. Controls were assessed on the same measures on 2 occasions 10 weeks apart, prior to receiving the same program. Data were obtained for participants in the treatment group who also completed a clinical interview pre and post treatment using the Pediatric Anxiety Rating Scale (PARS), which is a composite score of child, parent and clinician anxiety ratings. Data for the 57 versus 41 were analyzed using the maximum likelihood estimation method.

Results: Results of the questionnaires demonstrated that the treatment group had significantly improved anxiety scores compared with controls on the Spence Child Anxiety Scale, and the Child Anxiety Life Interference Scale for child measures, but not for parent measures. The PARS scores showed significant reductions in anxiety symptoms from pre to post treatment. However, external validity is limited due to low sample size and lack of comparison group.

Conclusion: The findings support the utility of ProACTive treatment program for school children with anxiety.y.