The feelings club: randomized controlled evaluation of school-based CBT for anxious or depressive symptoms

Depress Anxiety. 2010 Oct;27(10):945-52. doi: 10.1002/da.20724.


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:

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Anxiety / diagnosis
  • Anxiety / psychology
  • Anxiety / therapy*
  • Anxiety Disorders / prevention & control
  • Canada
  • Child
  • Child Behavior
  • Cognitive Behavioral Therapy*
  • Depression / diagnosis
  • Depression / psychology
  • Depression / therapy*
  • Depressive Disorder / prevention & control
  • Emotions
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Outcome and Process Assessment, Health Care
  • Psychiatric Status Rating Scales
  • Psychotherapy, Group*
  • Schools

Associated data

  • ISRCTN/ISRCTN88858028