Classroom-based cognitive behavioural therapy: a large-scale non-randomised controlled trial of the \u2018Journey of the Brave\u2019

Yuko Urao,Takako Koshiba,Ikuyo Ohira,Yasunori Sato,Eiji Shimizu,Shin-Ichi Ishikawa

doi:10.1186/s13034-021-00374-6

Abstract

BackgroundIn Japan, ‘Journey of the Brave’, a cognitive behavioural therapy (CBT)-based anxiety preventive education programme, was previously developed and its effectiveness examined in two small-scale controlled trials. These studies had some limitations, including a small number of participants and not having regular classroom teachers as programme facilitators. Therefore, we conducted a large-scale controlled trial, with teachers as programme implementers.MethodsTwenty-seven elementary schools participated: 1622 and 1123 children were allocated to the intervention and control groups, respectively. The intervention group received a programme comprising ten 45-min sessions, while the control group underwent the regular school curriculum. Anxiety symptoms among participants were assessed using the Spence Children’s Anxiety Scale (SCAS) at three stages (pre-intervention, post-intervention, and follow-up).ResultsFollowing primary analysis, estimated mean changes in SCAS from baseline to follow-up were − 4.91 (95% CI − 5.91, − 3.90) in the intervention group and − 2.53 (95% CI − 3.52, − 1.54) in the control group; the group difference was 2.37 (95% CI 1.42, 3.33, p < 0.0001). Children in the intervention group showed significant reduction in their anxiety score versus children in the control group.ConclusionsThe results showed a statistically significant anxiety score reduction in the intervention group, thus verifying the programme’s effectiveness.Trial registration The University Hospital Medical Information Network (UMIN): UMIN000032517. Registered 10 May 2018—Retrospectively registered, https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000037083

Highlights

In Japan, ‘Journey of the Brave’, a cognitive behavioural therapy (CBT)-based anxiety preventive educa‐ tion programme, was previously developed and its effectiveness examined in two small-scale controlled trials
We developed the ‘Journey of the Brave’ programme (JOB) with the motivation that it is necessary to develop a programme that is effective even when it is facilitated by elementary school teachers in Japan
This study found significant anxiety score reductions in the intervention group, with the effects again being maintained at 3-month follow-up [38]

Summary

Introduction

In Japan, ‘Journey of the Brave’, a cognitive behavioural therapy (CBT)-based anxiety preventive educa‐ tion programme, was previously developed and its effectiveness examined in two small-scale controlled trials. These studies had some limitations, including a small number of participants and not having regular classroom teach‐ ers as programme facilitators. Anxiety disorders are the most common mental health conditions affecting both children and adolescents [1,2,3]. School-based preventative approaches that target mental disorders may be approximately divided into two categories: targeted and universal approaches. Conducting programme sessions during school hours is a preferred method because all children can receive mental and physical health education in their natural environment, making the school an appropriate location for preventive education programmes [23]

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