Paula Barrett

Posted on January 27, 2012 by admin

Child and adolescent obsessive–compulsive disorder (OCD) is a chronic and debilitating condition that accrues significant concurrent and long-term risk to affected youth (Bolton, Luckie, & Steinberg, 1995; Hanna, 1995; Piacentini, Bergman, Keller, & McCracken, 2003; Pine, Cohen, Gurley, Brook, & Ma, 1998). More common than once thought, the disorder affects between 0.5% and 2% of children and adolescents (Flament et al., 1988; Heyman et al., 2003;Rapoport et al., 2000; Zohar, 1999), thus paralleling the prevalence rates reported within the adult population (Torres et al., 2006; Weissman et al., 1994). Growing awareness of the scope and impact of the disorder has been met with heightened research activity focused on identifying effective interventions, both psychosocial and  psychopharmacological, for youth with OCD. Such work has generated an emerging evidence base and has spurred the publication of expert consensus guidelines (March, Frances, Kahn, & Carpenter, 1997) and practice parameters (American Academy of Child and

Adolescent Psychiatry, 1998) for the treatment of this disorder. Both sets of guidelines recommend exposurebased cognitive behavioral therapy (CBT), either alone or in conjunction with a serotonin reuptake inhibitor (SRI) as a frontline intervention for youth with OCD. Although not empirically based, such guidelines undoubtedly mark a big step forward for enhancing treatment for youth with OCD; however, there is still much to be done to further understand and improve the available treatments for these youngsters. In this article, we provide a brief discussion of the phenomenology of child and adolescent OCD and the theory underlying current treatment approaches. We then review the current state of the psychosocial treatment research literature, evaluating the specific studies comprising this literature base relative to the criteria for classification as an evidence-based intervention. We discuss mediators, moderators, and predictors of treatment outcome as well as the implications and clinical generalizability of findings to date. We conclude with a discussion of recommendations for best practice and future directions that stem from this body of work.

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Paula Barrett

Posted on January 24, 2012 by admin

Emotional disturbances in children and youth occur at alarmingly high rates, are associated with a number of negative life consequences, and come at a tremendous cost to society. A Year Book of Australia report indicated that 20% of children between the ages of 12 and 16 had a significant mental health problem (Stanley, 2002). Anxiety disorders are the most frequently experienced mental health disorder in childhood and adolescence, with studies stimating a point prevalence of 5% to 10% and a lifetime prevalence of approximately 20% (Essau, Condradt, & Petermann, 2000; Shaffer, Fischer, Dulcan, & Davies, 1996). Research has demonstrated that anxiety and depressive

symptoms are highly related in child and youth populations (e.g., Dobson, 1985; Tannenbaum, Forehand, & Thomas, 1992). Estimates indicate approximately 2% to 5% of children and adolescents will suffer a major depressive disorder of clinical severity (Kashani et al., 1987; Lewinsohn, Clarke, & Rohde, 1994). Beyond the high prevalence rates, these emotional disorders are associated with a wide range of psychosocial impairments, tend to be chronic and unremitting in course, and are associated with significant risk for other psychological disorders if left untreated (e.g., Cole, Peeke, Martin, Truglio, & Seroczynski, 1998; Kashani & Orvaschel, 1990; Last, Hansen, & Franco, 1997; Orvaschel, Lewinsohn, & Seeley, 1995).

There has been a recent surge in the field of prevention research for children and youth. Given the potential of such approaches to impact on the incidence and prevalence of childhood emotional disorders, the need for evidence-based prevention is strong. Primary preventive interventions can be defined as either universal, selected, or indicated and targeted (Mrazek & Haggerty, 1994). Universal interventions target whole population groups, selective interventions involve children and youth identified as at risk of psychological problems, and indicated interventions target individuals identified with mild to moderate symptoms of a disorder (Mrazek & Haggerty, 1994). Universal prevention interventions conducted in the school context have many advantages, including reducing recruitment, screening, and attrition difficulties; reaching a broad range of children and adolescents with varying levels of risk for psychopathology; reducing stigmatization; enhancing peer support; and reducing psychosocial difficulties within the classroom—thus promoting  learning and healthy development (Evans, 1999; Kubiszyn, 1999). Support for preventative outcomes based on the delivery of cognitive behavioral interventions in schools is growing.

The Queensland Early Intervention and Prevention of Anxiety Project (Dadds, Spence, Holland, Barrett & Laurens, 1997) represented the first cognitive behavioral trial for prevention of childhood anxiety. This study targeted children (ages 7 to 14 years) who were disorder-free but exhibited anxious symptomatology (indicated prevention; Mrazek & Haggerty, 1994) as well as children who met criteria for an anxiety disorder but were in the less severe range (early intervention; Mrazek & Haggerty, 1994). Screening identified 128 eligible participants who were randomly allocated to either an intervention or a control condition. Diagnostic status was used as an outcome measure, and results were favorable. Both groups demonstrated improvement immediately postintervention; however, by 6-month follow-up, the improvement was maintained in the intervention group only. No differences between groups were evident at 12-month follow-up; however, at the 2-year follow-up, intervention effectiveness was demonstrated through the reduction of existing rates of anxiety disorder and prevention of the onset of new

anxiety disorders (Dadds, Spence, Laurens, Mullins,& Barrett, 1999). Consistent with prior research (Last, Perrin, Hersen, & Kazdin, 1996), regardless of intervention status, participants in this study showed a general improvement across time; results further revealed gender (female), parental anxiety and pretreatment severity predicted poor response to intervention (Barrett, Dadds, & Rapee, 1996; Cobham, Dadds, & Spence, 1998). This study  emonstrated that anxiety disorders and the number of children at risk of anxiety can be successfully reduced through selected school-based cognitive–behavioral intervention. An interesting outcome was putative delay in intervention effects, which is consistent with the results of a similar prevention trial for adolescent depression (Jaycox, Reivich, Gillham, & Seligman, 1994).

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Paula barrett

Posted on January 23, 2012 by admin

S T R E S S AND ANXIETY in school-age children and teenagers are broadly considered to be a normal part of development – serving to enhance performance or provide a protective defense against interpersonal threats. For select individuals, however, when adverse circumstances cause excessive worries and sadness, personal apprehension can be extremely debilitating (Treadwell, Flannery-Schroeder, & Kendall, 1995). The goal of much clinical research in recent years has been to identify the risk and protective mechanisms that mediate psychological health and dysfunction. With a better understanding of the relationship between situational and internal characteristics of emotional distress, mental health professionals have been better equipped to develop prevention, emotional resiliency training (early intervention), and treatment programs to address the specific needs of children and youth at risk (Barrett, Dadds, & Rapee, 1996; Kendall et al., 1997; Shortt, Barrett, & Fox, 2001; Silverman et al., 1999). Unfortunately, research to date has been disproportionately focused on Anglo youth, largely neglecting growing multicultural populations.

Over the past decade, cross-cultural research has highlighted the plight of children and teenagers who migrate with their families to countries of diverse culture. Whether migrating under refugee status, or for political/economic reasons, children and teenagers of non-English speaking background (NESB) migrating families are confronted with a plethora of situational and emotional difficulties (Barrett, Sonderegger, & Sonderegger, in press; Sam, 2000).

Early cross-cultural literature identifies components that mediate the amount of stress that children and adolescents experience when adjusting to a new cultural environment.

Psychosocial prevention, early intervention, and treatment programs in the school setting that feature cognitive-behavioral counseling approaches, are increasingly recognized as valid and effective tools in building emotional resiliency against psychological distress (Barrett, 1999; Barrett, Lowry, & Wallis, 1999). However, clinical studies incorporating their use with non-Anglo populations are unfortunately rare. Of the few empirical trials that have been conducted with NESB populations, conclusions have been limited by a myriad of methodological difficulties.

A preliminary treatment–wait-list comparison trial examining the utility of the FRIENDS program with clinically anxious female teenage refugees from the former- Yugoslavia (Barrett, Moore, & Sonderegger, 2000) revealed the cognitive-behavior therapy program to be effective in reducing emotional distress. Although intervention participants reported significantly lower levels of anxiety at post treatment than teenagers participating in a control condition, the small treatment sample size (n = 9) rendered statistical power unable to determine the program’s ethnic applicability and efficacy with any real degree of certainty. In an attempt to generate greater statistical power and trial cognitive-behavioral program techniques across different age groups (elementary and high schools), genders, and cultural groups, Barrett et al. (2001) replicated and expanded initial research endeavors.

S T R E S S AND ANXIETY in school-age children and teenagers are broadly considered to be a normal part of development – serving to enhance performance or provide a protective defense against interpersonal threats. For select individuals, however, when adverse circumstances cause excessive worries and sadness, personal apprehension can be extremely debilitating (Treadwell, Flannery-Schroeder, & Kendall, 1995). The goal of much clinical research in recent years has been to identify the risk and protective mechanisms that mediate psychological health and dysfunction. With a better understanding of the relationship between situational and internal characteristics of emotional distress, mental health professionals have been better equipped to develop prevention, emotional resiliency training (early intervention), and treatment programs to address the specific needs of children and youth at risk (Barrett, Dadds, & Rapee, 1996; Kendall et al., 1997; Shortt, Barrett, & Fox, 2001; Silverman et al., 1999). Unfortunately, research to date has been disproportionately focused on Anglo youth, largely neglecting growing multicultural populations.

Over the past decade, cross-cultural research has highlighted the plight of children and teenagers who migrate with their families to countries of diverse culture. Whether migrating under refugee status, or for political/economic reasons, children and teenagers of non-English speaking background (NESB) migrating families are confronted with a plethora of situational and emotional difficulties (Barrett, Sonderegger, & Sonderegger, in press; Sam, 2000).

Early cross-cultural literature identifies components that mediate the amount of stress that children and adolescents experience when adjusting to a new cultural environment.

Psychosocial prevention, early intervention, and treatment programs in the school setting that feature cognitive-behavioral counseling approaches, are increasingly recognized as valid and effective tools in building emotional resiliency against psychological distress (Barrett, 1999; Barrett, Lowry, & Wallis, 1999). However, clinical studies incorporating their use with non-Anglo populations are unfortunately rare. Of the few empirical trials that have been conducted with NESB populations, conclusions have been limited by a myriad of methodological difficulties.

A preliminary treatment–wait-list comparison trial examining the utility of the FRIENDS program with clinically anxious female teenage refugees from the former- Yugoslavia (Barrett, Moore, & Sondere

S T R E S S AND ANXIETY in school-age children and teenagers are broadly considered to be a normal part of development – serving to enhance performance or provide a protective defense against interpersonal threats. For select individuals, however, when adverse circumstances cause excessive worries and sadness, personal apprehension can be extremely debilitating (Treadwell, Flannery-Schroeder, & Kendall, 1995). The goal of much clinical research in recent years has been to identify the risk and protective mechanisms that mediate psychological health and dysfunction. With a better understanding of the relationship between situational and internal characteristics of emotional distress, mental health professionals have been better equipped to develop prevention, emotional resiliency training (early intervention), and treatment programs to address the specific needs of children and youth at risk (Barrett, Dadds, & Rapee, 1996; Kendall et al., 1997; Shortt, Barrett, & Fox, 2001; Silverman et al., 1999). Unfortunately, research to date has been disproportionately focused on Anglo youth, largely neglecting growing multicultural populations.

Over the past decade, cross-cultural research has highlighted the plight of children and teenagers who migrate with their families to countries of diverse culture. Whether migrating under refugee status, or for political/economic reasons, children and teenagers of non-English speaking background (NESB) migrating families are confronted with a plethora of situational and emotional difficulties (Barrett, Sonderegger, & Sonderegger, in press; Sam, 2000).

Early cross-cultural literature identifies components that mediate the amount of stress that children and adolescents experience when adjusting to a new cultural environment.

Psychosocial prevention, early intervention, and treatment programs in the school setting that feature cognitive-behavioral counseling approaches, are increasingly recognized as valid and effective tools in building emotional resiliency against psychological distress (Barrett, 1999; Barrett, Lowry, & Wallis, 1999). However, clinical studies incorporating their use with non-Anglo populations are unfortunately rare. Of the few empirical trials that have been conducted with NESB populations, conclusions have been limited by a myriad of methodological difficulties.

A preliminary treatment–wait-list comparison trial examining the utility of the FRIENDS program with clinically anxious female teenage refugees from the former- Yugoslavia (Barrett, Moore, & Sonderegger, 2000) revealed the cognitive-behavior therapy program to be effective in reducing emotional distress. Although intervention participants reported significantly lower levels of anxiety at post treatment than teenagers participating in a control condition, the small treatment sample size (n = 9) rendered statistical power unable to determine the program’s ethnic applicability and efficacy with any real degree of certainty. In an attempt to generate greater statistical power and trial cognitive-behavioral program techniques across different age groups (elementary and high schools), genders, and cultural groups, Barrett et al. (2001) replicated and expanded initial research endeavors.

gger, 2000) revealed the cognitive-behavior therapy program to be effective in reducing emotional distress. Although intervention participants reported significantly lower levels of anxiety at post treatment than teenagers participating in a control condition, the small treatment sample size (n = 9) rendered statistical power unable to determine the program’s ethnic applicability and efficacy with any real degree of certainty. In an attempt to generate greater statistical power and trial cognitive-behavioral program techniques across different age groups (elementary and high schools), genders, and cultural groups, Barrett et al. (2001) replicated and expanded initial research endeavors.

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Paula Barrett

Posted on January 21, 2012 by admin

Research into adult anxiety has shown that anxious adults frequently display cognitive biases in the processing of environmental stimuli (MacLeod, Mathews, & Tata, 1986). Compared with nonclinic subjects, they are more likely to interpret ambiguous material as threatening and tend to think that negative threatening events are more likely to happen to themselves than anyone else (Butler & Mathews, 1983). One question which has remained

untested is whether cognitive biases in anxious adults are established in adulthood or were already present at a young age. Retrospective studies have indicated that anxious adults often report having experienced high anxiety as children, raising the question of whether some of these cognitive biases were already present in childhood (Mattison, 1992). In studies of aggressive children, for example, Dodge (1986) has found that such children display a bias toward excessive attributions of hostile intentions in others. However, to date, there has not been similar published research with other groups of children.

Some recent research has attempted to examine the way in which feared outcomes are represented in long-term memory (Campbell & Rapee, 1994; Lovibond & Rapee, 1993). These studies have indicated that children seem to represent threatening outcomes in a very similar way to adults. Specifically, feared outcomes seem to be organized along two major factors: physical threat (physical harm) and social threat (negative evaluation). Another interesting research question, then, is whether people with different symptomatologies (predominantly social or physical fears), and different anxiety diagnoses, manifest different interpretation and response biases to ambiguity related specifically to physical or social situations.

In addition to the important role which cognitive factors may play in the maintenance of child anxiety, a large body of research has indicated that child psychopathology generally needs to be understood in the context of family interactional patterns (Dadds, 1987; Patterson & Reid, 1984). While direct observational studies of family processes with anxious children are rare (cf. Dadds, Barrett, Rapee, & Ryan, in press), there exists indirect evidence to support the role of family processes in the development of childhood anxiety.

Epidemiological studies (Klein & Last, 1989) point to the familial transmission of anxiety disorders. Studies of parents of anxious children find that they tend to selectively focus on future negative outcomes for their children’s current activities (Kortlander, Kendall, & Chansky, 1990). Krohne and Hock (1991) have suggested a “two-process model” that deals with the relationship between specific styles of parental child-rearing and coping dispositions in the children. Empirical tests of their model show that high anxiety in a child is significantly related to frequent negative feedback and parental restriction (Krohne & Hock, 1991). Hence, it is plausible that anxious children might learn to expect negative consequences for their behavior and as a result become fearful and avoidant. Recent clinical studies have further confirmed that the involvement of families in the treatment of anxious children is more effective than just treating the child (Barrett, Dadds, Rapee, & Ryan, in press; Dadds, Heard, & Rapee, 1991; King,Hamilton, & Ollendick, 1988).

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Paula Barrett

Posted on January 20, 2012 by admin

TREATMENT OF CHILDHOOD and adolescent anxiety has garnered increasing attention over the last decade. For the majority of children, anxiety is a common, functional, and transitory experience (Last, Perrin, Hersen, & Kazdin, 1996), the nature and intensity of which varies, at least in part, according to the child’s developmental stage. For example, young children often experience anxiety when separated from main attachment figures or if exposed to dark, unfamiliar places. In comparison, the anxieties expressed by adolescents relate more commonly to social identification and interpersonal issues. Unfortunately, for a large proportion of children and adolescents, anxiety may increase in intensity, becoming chronic and developmentally dysfunctional.

For these young people and their families, normal daily activities are usually disturbed and anxiety becomes a pervasive, intrusive problem requiring clinical intervention (Messer & Beidel, 1994). This is reflected in the fact that anxiety disor-ders are the most prevalent type of psychological disorder experienced by children and teenagers (Albano, Chorpita, & Barlow, 1996; Bernstein & Borchardt, 1991). Of further relevance to the present discussion is the observation that for those children and adolescents who experience chronic anxiety, but remain untreated, the prognosis is significantly poorer (Dadds, Barrett, & Cobham, 1997). Keller et al. (1992) assessed past and present psychopathology in 725 children and adolescents aged 6 to 19 years who were recruited in order to study the effects of parental affective illness on children.

Fourteen percent of the children were found to have a history of an anxiety disorder, and of these children, only 34% were free of an anxiety diagnosis at the assessment period. The average duration of the disorder at the time of assessment was reported as 4 years. Other research noted that children with an anxiety disorder were still likely to fulfil diagnostic criteria up to 8 years after the onset of the disorder (Kovacs & Devlin, 1998). There is some indication, then, that childhood disorders may be more chronic and enduring than initially thought. Initial approaches to the treatment of childhood anxiety used elements and processes from adult treatment models, derived from adult-based theories, with terminology adapted for a youth population. In this regard, the childhood anxiety field is not unlike many others in clinical child psychology that have been built on the foundations of adult treatment paradigms. More recently, however, there has been a growing recognition of the need to consider developmental factors as they relate to the etiology, assessment, and treatment of various childhood disorders. Given the potential for anxiety problems to occur across the lifespan, as well as the established links between childhood anxiety disorders and psychological disorder later in life (Kovacs & Devlin, 1998), the application of a developmental perspective in the treatment of childhood anxiety seems warranted.

The impact of developmental factors is further mediated by the cultural context and background of the family and society to which the young person belongs. One illustration is the observation that Portuguese children, from a nonclinical population, report more fears on average than do English children (Fonseca, Yule, & Erol, 1994). Moreover, a perusal of Portuguese research on parent–child relationships indicates that it is culturally appropriate for children as old as 7 years to sleep in their parents’ bedroom; a custom that would find less favour within Anglo-Saxon-based cultures. It has been argued that a major failing of current clinical research is its dependence upon a culturally narrow (western, middle-class) definition of psychopathology and mental health (Kaslow & Thompson, 1998). A careful examination of practices in countries of non-English-speaking background would likely lead to a re-think of our culturally bound definitions of what is developmentally appropriate and what warrants clinical intervention.

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Paula Barrett

Posted on January 19, 2012 by admin

Anxiety difficulties are among the common psychological problems reported by children (Mattison,1992), and many anxious adults report their problems originated in childhood (Rapee & Barlow, 1993). For most children, various fears occur as part of normal childhood development. However, for some, these fears intensify and persist over time, preventing the child from enjoying age-related activities and thereby warranting clinical attention. For example, Klein and Last (1989) reported that anxiety has a negative effect on children’s general social adjustment. Anxiety problems occur in 10-20% of school-age children; the more general anxiety disorders that have a major impact on children’s functioning, such as overanxious disorder, separation anxiety, and social phobias, are found in approximately 5% to 10% of children (Weny,1986)

Research is limited in relation to the treatment of childhood anxiety disorders, and most of those carried out have used single case designs in the treatment of simple phobias and specific fears in chilclren (King,Hamilton, & Ollendick, 1988). Studies of cognitive-behavioral treatment of childhood anxiety, s~uccessfully using a combination of behavioral techniques (in vivo exposure, relaxation, and contingency management) and cognitive coping skills (self-instructional training), have mainly concentrated on school fears, nighttime fears, and fears of medical procedures (Kertdall, et al.,1992). Group treatment has not been consiclered in the existing research despite findings revealing that group contingencies promote peer support, reinfortcement opportunitnes,sharing of resources, and increased prompting and modeling of desirable behaviors (Kazdin, 1994).

Family factors have been shown to be commonly associated with the development and maintenance of childhood anxiety; such factors include parental anxiety and depression, family conflict, marit,al discord, and parental reinforcement of avoidant coping strategies (Barrett, Rapee, Dadds, & Ryan, 19!96; Bruch, Heimberg, Berger, & Collins, 1989; Turner., Beidel, & Epstein, 1991:). Further, there is growing evidence suggesting that anxiety in children is significantly related to frequent negative feedback and parental restriction (Barrett et al., 1996; Krohne & Hock, 1991). Moreover, recent experimental studies have provided evidence for the support of a childhood anxiety model based on the development of an anxious cognitive style in the context of anxiety-supporting family processes.

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paula barrett

Posted on December 6, 2011 by admin

Barrett et al 2001 Cognitive behavioural treatment of anxiety disorders in children_JConsultingClinicalPsychology

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Baula Barrett Dog Stealing positive behaviour reinforcement

Posted on November 25, 2011 by admin

Paula Barrett dog stealing, dog theft, dog napping court

paula barrett dog theft stealing napping court

TOP 5 TIPS

The Dog Trainer host Jolanta Benal is a Certified Professional Dog Trainer – Knowledge Assessed (www.ccpdt.org), working with private clients who need help with general manners or with serious difficulties such as aggression and separation anxiety. She also participates in the Safety Net program of New York City’s municipal animal shelter system, working to keep pets in their homes. Her approach is generally behaviorist (Pavlovian, Skinnerian and post-Skinnerian learning theory) with a big helping of ethology (animal behavior as observed in non-experimental settings). She’s happy to report that the science supports dog-friendly, human-friendly training, with plenty of rewards and fun. Check out Jolanta’s book, The Dog Trainer’s Complete Guide to a Happy, Well-Behaved Pet.

Dogs Who Steal Your Stuff

by Jolanta Benal

On many a day in many a household, the cry is raised: “Dogalini! What is that! No! Give it back right now!” Yes, it’s the Sneaky Thievin’ Thiefy Dog episode, otherwise known as the Perfectly Normal Dog episode, of The Dog Trainer’s Quick and Dirty Tips for Teaching and Caring for Your Pet.

Object Nabbing – A Popular Pastime

I’d bet a lot of money that every pet dog with the power of locomotion has gotten in trouble at home for nabbing socks, shoes, plastic soda bottles, counter sponges, and other ordinary and not-so-ordinary household items. Today, why they do it, how to direct their time and energy someplace else, and what not to do unless you want to turn normal dog behavior into a serious problem.

Why Dogs “Steal” Objects

First, the why. One thing about dogs, you never have to look for deep dark motivations. They act like rascals because they’ve got unburned energy lying around. They’re a little bit bored and want some action. They’re a little bit lonely and want some attention. The item they nab smells like you. The item they nab smells like food. The item they nab has just the right chewy texture.

That list of whys, conveniently enough, turns right into a list of problem-solving tactics.

Fix No. 1: Exercise

If you’ve got an active young dog, be sure to provide a solid hour of aerobic exercise every day. The meaning of “young” varies from breed to breed and individual to individual. Though large dogs tend to have shorter life spans thansmall dogs, they may remain puppylike for several years. Dogs with a working or hunting heritage – Border Collies and German Short-haired Pointers, for two – were bred for sustained activity and will go stir crazy if they spend all day lying on the couch. Let me rephrase that: they won’t spend all day lying on the couch, and they will go stir crazy looking for something to do.

Fix No. 2: Mental Stimulation and Attention

Exercise is half the cure for boredom; mental stimulation is the other half. Many people notice that their puppy or dog’s shoe-stealing evil twin appears at more or less the same time every day. Scheduling a 5- or 10-minute session of reward-based training just before that often preempts the witching hour entirely. It also meets your dog’s need for attention – and attention is a need; dogs are social animals. Nobody enjoys a bored dog’s pestering, but it’s reasonable for our dogs to want some of our time, focus, and affection every day.

Food-Dispensing Toys

Also great for burning off mental steam: food-dispensing toys. Why should dinner take 4.5 seconds? Pack a mix of half canned, half dry food in a hollow rubber toy such as the Kong, freeze it overnight, and welcome your dog to the Slow Food movement. Extracting his food from its rubber prison will carry him right through that time of the evening when he would otherwise be checking out your kitchen counters and the dirty laundry. And remember the smells-like-food and chewy-texture motivators for object-nabbing? You’ve just taken care of those, too. For more tips on how to keep your dog from counter surfing, check out my episode on food-stealing.

Prevention (AKA Cleaning Up After Yourself)

While you’re enriching your puppy or dog’s life, don’t overlook plain old management as a training tool. Shoes go in the closet. Dirty laundry goes in the laundry bag. Clean laundry gets put away. Tupperware containers bearing traces of last night’s pasta salad need not remain on the dining room table while you zone out in front of the TV. That inquisitive animal who lives with you evolved as a scavenger, and if you leave interesting stuff around of course she will sooner or later scavenge it. A puppy who grows up focused on exercise, legal chewies, and training time with you may rarely or never feel the need to poke around looking for snacks and fun. But once a snatch-and-grab habit has taken root, it’s as hard to shake as cigarettes. Prevent access, provide alternative outlets, and don’t blame your dog for her occasional lapses.

What to Do When Your Dog “Steals” Something

What to do about those? Take a deep breath and keep your cool. Shouting at your dog and rushing her to grab her prize is likely to produce a game of keep-away at best. At worst, she perceives a threat and gets scared and defensive. This is especially likely if you grab her, roll her over, and pry her jaws open to take whatever it is away. From your dog’s point of view, this is socially peculiar, to say the least. Imagine how you’d feel if out of the blue a close friend punched you and took your wallet away. Dogs repeatedly subjected to this kind of behavior may escalate from object “stealing” to object guarding. Human approach now constitutes a threat, and the canine response to a threat isgrowling, snapping, even biting.

Ignore “ Dog Theft,” or Distract or Bribe Your Dog If Necessary

If the object Dogalini’s gotten hold of is harmless and inexpensive, your best bet is to ignore her. No agitation, and no attention given to that attention-seeking grab-and-snatch. But if that’s your favorite shoe she’s got, or a potentially toxic food, go with distraction and bribery. Suddenly discover something fascinating at the other end of the room. Throw a ball. Pick up the leash and invite Dogalini for a walk. Or walk up to her quietly and trade her a bit of cheese or meat for whatever she has nabbed. Yes, the lesson for Dogalini is that stealing your socks induces you to part with your cheese or take her on a surprise inspection of the local fire hydrants. Never mind; you’re in damage control mode. “My people will give treats in exchange for my prize finds” is a much better lesson than “My people get weird and scary when they want something I’ve got.” As for you, review your canine theft-prevention exercises and remember to put away your shoes.

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Paula Barrett : long-term effectiveness of the FRIENDS Program

Posted on September 12, 2010 by admin

Paula Barrett : long-term effectiveness of the FRIENDS Program

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Long-Term Outcomes of an Australian Universal Prevention Trial of
Anxiety and Depression Symptoms in Children and Youth: An Evaluation
of the Friends Program
Paula M. Barrett a; Lara J. Farrell a; Thomas H. Ollendick b; Mark Dadds c
a University of Queensland, Pathways Health and Research Centre, Brisbane, Australia. b Virginia
Polytechnic Institute and State University, Blacksburg. c University of New South Wales, Sydney,
Australia.
To cite this Article Barrett, Paula M., Farrell, Lara J., Ollendick, Thomas H. and Dadds, Mark(2006) ‘Long-Term Outcomes
of an Australian Universal Prevention Trial of Anxiety and Depression Symptoms in Children and Youth: An Evaluation
of the Friends Program’, Journal of Clinical Child & Adolescent Psychology, 35: 3, 403 — 411
To link to this Article: DOI: 10.1207/s15374424jccp3503_5
URL: http://dx.doi.org/10.1207/s15374424jccp3503_5
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or indirectly in connection with or arising out of the use of this material.
Long-Term Outcomes of an Australian Universal Prevention Trial
of Anxiety and Depression Symptoms in Children and Youth:
An Evaluation of the Friends Program
Paula M. Barrett
University of Queensland, Pathways Health and Research Centre, Brisbane, Australia
Lara J. Farrell
University of Queensland, Pathways Health and Research Centre, Brisbane, Australia
Thomas H. Ollendick
Virginia Polytechnic Institute and State University, Blacksburg
Mark Dadds
University of New South Wales, Sydney, Australia
This study evaluated the long-term effectiveness of the FRIENDS Program in reducing
anxiety and depression in a sample of children from Grade 6 and Grade 9 in comparison
to a control condition. Longitudinal data for Lock and Barrett’s (2003) universal
prevention trial is presented, along with data from 12-month follow-up to 24-
and 36-month follow-up. Results of this study indicate that intervention reductions in
anxiety reported in Lock and Barrett were maintained for students in Grade 6, with
the intervention group reporting significantly lower ratings of anxiety at long-term
follow-up. A significant Time Ă— Intervention Group Ă— Gender Effect on Anxiety was
found, with girls in the intervention group reporting significantly lower anxiety at
12-month and 24-month follow-up but not at 36-month follow-up in comparison to
the control condition. Results demonstrated a prevention effect with significantly
fewer high-risk students at 36-month follow-up in the intervention condition than in
the control condition. Results are discussed within the context of prevention research.
Emotional disturbances in children and youth occur
at alarmingly high rates, are associated with a number
of negative life consequences, and come at a tremendous
cost to society. A Year Book of Australia report
indicated that 20% of children between the ages of
12 and 16 had a significant mental health problem
(Stanley, 2002). Anxiety disorders are the most frequently
experienced mental health disorder in childhood
and adolescence, with studies estimating a point
prevalence of 5% to 10% and a lifetime prevalence of
approximately 20% (Essau, Condradt, & Petermann,
2000; Shaffer, Fischer, Dulcan, & Davies, 1996). Research
has demonstrated that anxiety and depressive
symptoms are highly related in child and youth populations
(e.g., Dobson, 1985; Tannenbaum, Forehand, &
Thomas, 1992). Estimates indicate approximately 2%
to 5% of children and adolescents will suffer a major
depressive disorder of clinical severity (Kashani et al.,
1987; Lewinsohn, Clarke, & Rohde, 1994). Beyond
the high prevalence rates, these emotional disorders are
associated with a wide range of psychosocial impairments,
tend to be chronic and unremitting in course,
and are associated with significant risk for other psychological
disorders if left untreated (e.g., Cole,
Peeke, Martin, Truglio, & Seroczynski, 1998; Kashani
& Orvaschel, 1990; Last, Hansen, & Franco, 1997;
Orvaschel, Lewinsohn, & Seeley, 1995).
There has been a recent surge in the field of prevention
research for children and youth. Given the potential
of such approaches to impact on the incidence and
prevalence of childhood emotional disorders, the need
for evidence-based prevention is strong. Primary preventive
interventions can be defined as either universal,
selected, or indicated and targeted (Mrazek &
Haggerty, 1994). Universal interventions target whole
population groups, selective interventions involve
children and youth identified as at risk of psychological
problems, and indicated interventions target individuals
identified with mild to moderate symptoms of
a disorder (Mrazek & Haggerty, 1994). Universal prevention
interventions conducted in the school context
have many advantages, including reducing recruitment,
screening, and attrition difficulties; reaching a
broad range of children and adolescents with varying
Journal of Clinical Child and Adolescent Psychology
2006, Vol. 35, No. 3, 403–411
Copyright © 2006 by
Lawrence Erlbaum Associates, Inc.
403
Correspondence should be addressed to Lara Farrell, School
of Applied Psychology, Mt. Gravatt Campus, Griffith University,
Queensland, Australia 4111. E-mail: l.healy@griffith.edu.au
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levels of risk for psychopathology; reducing stigmatization;
enhancing peer support; and reducing psychosocial
difficulties within the classroom—thus promoting
learning and healthy development (Evans, 1999;
Kubiszyn, 1999). Support for preventative outcomes
based on the delivery of cognitive behavioral interventions
in schools is growing.
The Queensland Early Intervention and Prevention
of Anxiety Project (Dadds, Spence, Holland, Barrett &
Laurens, 1997) represented the first cognitive behavioral
trial for prevention of childhood anxiety. This
study targeted children (ages 7 to 14 years) who were
disorder-free but exhibited anxious symptomatology
(indicated prevention; Mrazek & Haggerty, 1994) as
well as children who met criteria for an anxiety disorder
but were in the less severe range (early intervention;
Mrazek & Haggerty, 1994). Screening identified
128 eligible participants who were randomly allocated
to either an intervention or a control condition. Diagnostic
status was used as an outcome measure, and results
were favorable. Both groups demonstrated improvement
immediately postintervention; however, by
6-month follow-up, the improvement was maintained
in the intervention group only. No differences between
groups were evident at 12-month follow-up; however,
at the 2-year follow-up, intervention effectiveness was
demonstrated through the reduction of existing rates of
anxiety disorder and prevention of the onset of new
anxiety disorders (Dadds, Spence, Laurens, Mullins,&
Barrett, 1999). Consistent with prior research (Last,
Perrin, Hersen, & Kazdin, 1996), regardless of intervention
status, participants in this study showed a general
improvement across time; results further revealed
gender (female), parental anxiety and pretreatment severity
predicted poor response to intervention (Barrett,
Dadds, & Rapee, 1996; Cobham, Dadds, & Spence,
1998). This study demonstrated that anxiety disorders
and the number of children at risk of anxiety can be
successfully reduced through selected school-based
cognitive–behavioral intervention. An interesting outcome
was putative delay in intervention effects, which
is consistent with the results of a similar prevention
trial for adolescent depression (Jaycox, Reivich, Gillham,
& Seligman, 1994).
Barrett and Turner (2001) evaluated the effects of a
universal cognitive behavioral intervention for the prevention
of internalizing symptoms in children in Grade
6 (ages 9 to 10 years). Ten schools in the Brisbane region
participated in the project, which involved all
children participating in the FRIENDS program during
class time (Barrett, 2004, 2005; Barrett, Lowry-Webster,
& Turner, 1999a, 1999b). This study evaluated
a “train-the-trainer” model of intervention, whereby
children were assigned to one of three conditions: (a)
psychologist-led intervention, (b) teacher-led intervention
(following a standardized teacher training workshop),
or (c) standard curriculum (control condition).
Barrett and Turner (2001) trained classroom teachers
and psychologists to implement the 12-session
FRIENDS program as part of the standard classroom
curriculum. Parents were invited to attend four parent
evenings, which involved psychoeducation and parenting
strategies. Evaluation of children’s self-report
measures at postintervention indicated preventive effects,
with participants reporting significant reductions
in anxiety symptoms across psychologist and teacher
intervention conditions. This study provided preliminary
evidence for the effectiveness of the FRIENDS
program delivered by teachers at a school-based population
level, integrated within the standard school
curriculum.
Lowry-Webster, Barrett, and Dadds (2001) further
examined the effectiveness of the FRIENDS program
as a universal strategy for prevention of childhood anxiety.
In total, 594 students, ages 10 to 13 years, were allocated
to either an intervention or a control condition
on the basis of class. At postassessment, all children reported
significant reductions in anxiety, although these
decreases were significantly greater in the intervention
group compared to the control condition. A significant
reduction in depression was found for the intervention
group only. Further analysis of changes in risk status
showed positive findings. Of the children in the intervention
group at risk at preintervention, 75.3% were no
longer at risk at postintervention, compared to 54.8%
of high-risk children in the control group. Lowry-Webster,
Barrett, and Lock (2003) reported on outcomes at
12-month follow-up for this sample. Results indicated
that prevention effects were maintained up to the 12-
month follow-up for children who received the program.
The intervention group evidenced lower scores
on anxiety self-report measures, and the high-anxiety
children from the intervention condition reported reductions
in both anxiety and depression scores. Diagnostic
interview data demonstrated that 85% of children
in the intervention group who were scoring above
the clinical cutoff for anxiety and depression were
diagnosis-free at 12-month follow-up, compared to
only 31.2% of children in the control group. This follow-
up study demonstrated clinically and statistically
significant reductions in anxiety symptoms and disorders
from pretest to 12-month follow-up following the
FRIENDS universal program.
Most recently, Lock and Barrett (2003) presented
the results of a longitudinal school-based study of universal
prevention using the FRIENDS program across
two distinct age groups. This study involved a group of
733 children enrolled in Grade 6 (n = 336; ages 9 and
10 years) and Grade 9 (n = 401; ages 14 to 16 years)
from seven socioeconomically diverse schools in the
metropolitan area of Brisbane, Australia. Schools were
randomly assigned to either an intervention condition
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BARRETT, FARRELL, OLLENDICK, DADDS
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(FRIENDS) or a control condition (standard curriculum),
and all students completed self-report measures
of anxiety, depression, and coping. Students identified
as high risk based on elevated scores on an anxiety
measure were interviewed using a structured diagnostic
interview. As with previous research (e.g., Dadds
et al., 1997, 1999; Lowry-Webster et al., 2001, 2003),
this study found general reductions in anxiety across
time regardless of intervention condition; however,
these reductions were significantly greater for students
in the intervention condition at both posttest and
12-month follow-up. In terms of age differences, children
in Grade 6 reported significantly higher levels of
anxiety prior to the intervention and at postintervention
yet greater reductions in anxiety at 12-month followup,
as well as lower levels of depression across time
compared to Grade 9 children. This finding suggested
that the optimal time for preventing anxiety may be in
late childhood (9 to 10 years of age) versus early adolescence.
This study also examined gender differences
and found that girls were more likely to be at risk of an
anxiety disorder and tend to report higher levels of anxiety
than boys over time. Moreover, Grade 6 girls
were most responsive to the intervention, as they reported
greater reductions in anxiety compared to girls
in Grade 9 and boys across grades.
Lock and Barrett (2003) also examined the effects
of the intervention on depressive symptoms. Results
indicated that there significant reductions in depression;
however, this effect was only apparent at 12-
month follow-up, suggesting a delayed “prevention”
effect for depression. This finding of a delayed effect is
consistent with the finding from the Queensland Early
Intervention project (Dadds et al., 1997) and is also
consistent with Jaycox and colleagues (1994) prevention
trial for depression.
These preliminary studies have indicated significant
promise for the effectiveness of the FRIENDS
program as a selective, indicated, and universal prevention
program for schools. However, as the true preventive
impact of an intervention can better be determined
over a longer term, it is important to examine outcomes
beyond the 12-month follow-up. This study aims to
evaluate the long-term prevention outcomes at 24-
month and 36-month follow-up, compared to existing
data at 12-month follow-up reported in Lock and
Barrett’s (2003) longitudinal study. Students involved
in Lock and Barrett’s study were followed up again at
24 months and 36 months. This study evaluates outcomes
on measures of self-reported anxiety and depression
across intervention and control schools from
12-month follow-up to 24-month follow-up and 36-
month follow-up. It was hypothesized that intervention
gains from Lock and Barrett’s study would be maintained;
that is, there would be significantly lower
scores on anxiety and depression self-report across the
follow-up for children and youth in the intervention
condition in comparison to students in the control condition.
It was further hypothesized that there would be
significantly fewer students at high risk for anxiety
and depression in the intervention condition compared
with the control condition at each follow-up point.
Based on Lock and Barrett’s findings, it was anticipated
that prevention effects (maintenance of gains vs.
increases in symptoms over time) would be strongest
for children in the Grade 6 group compared with students
in the Grade 9 group and for girls compared to
boys.
Method
Participants
Participants included in this follow-up study were
669 children and youth from Lock and Barrett’s (2003)
original sample of 737 Grade 6 (age 10 to 11 years) and
Grade 9 (age 13 to 14 years) students. One school from
the original sample (control school, n = 68) withdrew
from the longitudinal study following the 12-month
follow-up. The sample at 12-month follow-up consisted
of 334 students in Grade 7 and 335 students in
Grade 10. These students were followed up again at 24
months (Grade 8 and Grade 11) and 36 months (Grade
9 and Grade 12). All participants were students from
one of six coeducational schools extending from preschool
to Year 12 in the metropolitan area of Brisbane,
Australia. Schools, rather than participants, were selected
as the unit of random assignment; with schools
randomly assigned to either an intervention condition
or a control condition. The schools remaining in this
study were three intervention schools and three control
schools. At 12-month follow-up, there were a total of
379 participating students (54% female) within the intervention
condition and a total of 290 participating
students within the control condition (48% female).
Socioeconomic status (SES) was based on paternal
occupation and was coded using the 9-point Australian
Standard Classification of Occupations Dictionary
(Australian Bureau of Statistics and Department of Education,
Training and Youth Affairs, 1997). The average
SES rating across schools was 5.67 (SD = 1.21),
typical of the SES distribution of Australia in general.
This value is indicative of middle SES on average (e.g.,
skilled, clerical, and trade occupations are coded as 5
and semiprofessional occupations as 6) and is broadly
consistent with the average SES reported in other Australian
studies (e.g., Spence, Barrett, & Turner, 2003).
The intervention and control schools did not differ
from each other on SES ratings. The majority of intervention
(89%) and control students (84%) were born in
Australia, with the remainder coming from a wide vari-
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UNIVERSAL SCHOOL-BASED ANXIETY PREVENTION PROGRAM
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ety of ethnic backgrounds, as is typical of the Australian
population.
Procedure
Informed consent and assignment to experimental
conditions. All schools participating in the project
were from the independent education sector, and
initial consent was obtained from the principal of each
school to invite students, their parents, and their teachers
to participate in a longitudinal research project.
Schools were matched in pairs based on geographical
location, and one school from each pair was randomly
assigned to either an intervention or a control condition.
All parents of students were sent an information
sheet describing the project and an informed consent
form to be completed and returned by parents. A good
consent rate was obtained for each grade level: Grade
6, 79.36%, and Grade 9, 77.62%. See Lock and Barrett
(2003) for further details.
Program evaluation—Long-term follow-up. In
this study, students were assessed at two time intervals:
24-month follow-up and 36-month follow-up. This data
will be compared with Lock and Barrett’s (2003) 12-
month follow-up data to evaluate change over time. All
questionnaire assessments were completed within class
groups, within normal school hours.Apostgraduate research
assistant read the instructions and questionnaires
aloud to all students while other project staff walked
around the classroom assisting students who required
help or indicated they did not understand one of the
questions. Students were informed that all questionnaire
responses were confidential. Questionnaires were
presented in a counterbalanced order within the assessment
package, with each school receiving a different ordering
of questionnaires, across each data collection
point.
Program implementation. The FRIENDS intervention
(discussed later) was implemented within
schools assigned to the intervention condition as part
of the curriculum within the subject areas of health and
physical education or social and personal development.
The intervention consists of 10 sessions of approximately
70 min each, with one session scheduled
per week over a 10-week term. There are two booster
sessions in the program, which were implemented in
the following term. Two developmentally tailored versions
of the program were implemented: FRIENDS for
Children (Barrett et al., 1999a) was offered to Grade
6 intervention participants and FRIENDS for Youth
(Barrett et al., 1999b) was implemented with Grade 9
intervention participants. The FRIENDS program is a
brief cognitive–behavioral intervention designed and
validated as an individual or group-based treatment for
clinically anxious children (Barrett et al., 1996; Shortt,
Barrett, & Fox, 2001). The program, described in detail
by Barrett (1999), assists children and youth in
learning important skills and techniques that help them
to cope with and manage anxiety and emotional distress
through the application of learned coping and
problem-solving skills. The FRIENDS program was
implemented by teachers with the assistance of clinically
trained psychology postgraduate students following
a 1-day standardized teacher-training workshop.
Teachers were the main facilitator for the sessions,
with the psychology students assisting children when
needed. An earlier study reported that there were no
differences in postintervention outcomes for students
who received the intervention led by teachers and students
who received the intervention led by psychologists
(see Barrett & Turner, 2001). The program also
incorporates four evening sessions for parents, which
are scheduled at regular intervals throughout the 10
weeks of the program. These psychoeducational sessions
provided parents with an opportunity to learn
about the program and to discuss parenting and reinforcement
strategies. FRIENDS is an acronym for the
different skills taught (F = feeling worried; R = relax
and feel good; I = inner helpful thoughts; E = explore
plans; N = nice work, reward yourself; D = don’t forget
to practice; and S = stay calm for life!).
Prior to implementing the program, group leaders
were each given a program fidelity checklist to record
whether they completed each activity within the session.
Of the 18 teachers who implemented the intervention,
only 5 returned fidelity checklists. Adherence
to the intervention content ranged from 72.3% to
91.66%.
Measures
Spence Children’s Anxiety Scale (SCAS). The
SCAS (Spence, 1997) is a 44-item scale assessing anxiety
symptoms. Six subscales, corresponding to Diagnostic
and Statistical Manual of Mental Disorders (4th
ed.; American Psychiatric Association, 1994) anxiety
disorders are calculated from the anxiety items and a
Total Anxiety score (used in this study) is obtained by
summing all subscales. Participants rate each symptom
on a 4-point scale corresponding to the frequency with
which they experience each symptom, and higher
scores reflect a greater number of anxiety symptoms.
Spence (1998) and Spence et al. (2003) reported high
internal consistency in community child (Cronbach’s
α = .92) and adolescent populations (Cronbach’s α =
.92), respectively, and 6-month test–retest reliability of
.60 for children (Spence, 1998) and 12-week test–retest
reliability of .63 for youth (Spence et al., 2003).
Good convergent and discriminant validity was also reported.
Analysis of internal consistency was conducted
for this sample at 12-month follow-up, with results in-
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BARRETT, FARRELL, OLLENDICK, DADDS
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dicating high internal reliability (Cronbach’s α = .89)
for this measure.
Revised Children’s Manifest Anxiety Scale
(RCMAS). The RCMAS (Reynolds & Richmond,
1985) provides a measure of anxiety symptomatology.
The questionnaire contains 37 items, 9 of which form a
Lie scale. For each item, the child is asked to respond
“yes” or “no.” This measure has been found to have
high internal consistency and test–retest reliability, as
well as showing convergent and divergent validity
(Reynolds & Richmond, 1985). The internal consistency
for this measure was high, based on responses
from this sample at 12-month follow-up, with a
Cronbach’s α of .85.
Children’s Depression Inventory (CDI). Depressive
symptoms were assessed using the 27-item
CDI (Kovacs, 1981). Items assess depressive symptoms
such as sadness, self-blame, loss of appetite, interpersonal
relationships, and school adjustment. For
each item, participants choose a statement from three
response alternatives, with each increasing in symptom
severity. Higher scores reflect more severe symptomatology.
In this study, and in line with other research
studies (e.g., Hannon, Rapee, & Hudson, 2000;
Shochet et al., 2001; Weiss et al., 1991), one item pertaining
to suicidal ideation was omitted due to concerns
expressed by school personnel and parent
groups. In comparing children’s scores in samples with
and without the suicide item, Weiss et al. (1991) reported
that deletion of the suicide item did not significantly
alter CDI scores. Cole, Hoffman, Tram, and
Maxwell (2000) reported high internal consistency in a
community sample of children and youth (Cronbach’s
α = .90) and 6-month test–retest reliability of .66. Internal
consistency for this measure based on this sample
at 12-month follow-up indicated high internal reliability
(Cronbach’s α = .89).
Results
Attrition and Missing Data
Patterns of missing data from 12-month follow-up
to 24-month follow-up and 36-month follow-up were
examined to determine dropout and absenteeism rates
to assess potential influences of these factors on the
long-term outcomes. At 24-month follow-up, there
were no differences in the frequency of missing data
across between grade (34% missing Grade 6, 33%
missing Grade 9), gender (34% missing male, 33%
missing female), or students at high risk (32% missing)
and in the healthy range (34% missing). There were
significant differences between the intervention and
the control conditions, with the control condition having
significantly more missing data (44%) than the intervention
group (25%), χ2(1, 669) = 26.09, p < .001.
At 36-month follow-up there were no differences in
the frequency of missing data between grade (47%
missing Grade 6, 46% missing Grade 9), gender (49%
missing male, 43% missing female), or students at high
risk (44% missing) and in the healthy range (47%
missing). There were significant differences between
the intervention and the control conditions, with the
control condition having significantly more missing
data (54%) than the intervention group (41%), χ2(1,
669) = 10.98, p < .01. Reasons for attrition at each time
point were absenteeism from school on the day of
assessment, students leaving the school, and absenteeism
from class due to extracurricular activities that
were occurring at the time of assessments (i.e., sports
meetings, music classes, learning assistance). Control
schools were less likely to provide additional opportunities
to screen children who were missing from class.
Single imputation via expectation maximization
method in SPSS was used for missing data in all analyses.
Risk Group Status
Participants were classified as high risk based on elevated
scores (above a specified cutoff) on either the
SCAS or the CDI. Given there were significant grade
and gender differences within this sample on the SCAS
at preintervention, this study used separate cutoffs for
grade and gender. The cutoffs used reflected the score
above which 10% of the normative sample scored
(Spence, 2005), which closely paralleled the mean
scores of the top 10% of this sample. The cutoff for the
CDI was 14 across all students given that there were no
significant grade or gender differences on the CDI at
preintervention in this sample. Table 1 presents the frequency
and percentage of students at high risk across
grade and intervention conditions at each time point.
Chi-square tests revealed significant differences between
the intervention and control conditions at 36-
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UNIVERSAL SCHOOL-BASED ANXIETY PREVENTION PROGRAM
Table 1. Frequency and Percentage of Students at High
Risk Across Intervention Conditions for Each Follow-Up
Time Point
12 Months 24 Months 36 Months
n % n % n %
Total Intervention 59 16 49 17 22 12a
Female 34 58 29 59 13 59
Male 25 42 20 41 9 41
Total Control 62 21 40 25 26 31a
Female 31 50 24 60b 13 42
Male 31 50 16 40b 13 50
aSignificance between intervention and control groups at 36 months,
p < .001. bSignificance between females and males within the control
condition at 24 months, p < .05.
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month follow-up, χ2(1, 261) = 13.57, p < .001, with
significantly more students in the control condition at
high risk. There were equal girls to boys at high risk
within the intervention and control conditions at each
time point, except at 24-month follow-up, when there
were significantly more girls at high risk within the
control condition, χ2(1, 162) = 3.65, p < .05.
Long-Term Follow-Up
of Universal Prevention Effects
Prior to evaluating prevention effects across time
and intervention condition, a three-level (schools, students,
and occasions) multilevel analysis was conducted
across the dependent variables (CDI, SCAS,
RCMAS) to examine whether there was a clustering
effect of schools. The results indicated that the
“schools” level of data accounted for less than 5%
of total variance across dependent measures; hence it
was concluded that there was no clustering effect of
schools. Further analyses were conducted using univariate
analysis of variance covarying preintervention
group differences (analyses of covariance) on all dependent
measures, given that these group differences
were significant and not controlled for in Lock and
Barrett’s study (2003). To evaluate the long-term prevention
effects of the FRIENDS program on measures
of anxiety and depression, 2 (group: intervention or
control) Ă— 2 (grade: Grade 6 or Grade 9) Ă— 2 (gender) Ă—
2 (risk: high risk or healthy) Ă— 3 (time: 12-month follow-
up, 24-month follow-up, 36-month follow-up) repeated-
measures analyses of covariance were conducted.
As a result of multiple comparisons being
examined, Bonferroni adjustments, based on student’s
t statistic, were used in SPSS for the repeated-measures
analyses to adjust the observed significance level and
control for experimentwise error due to the multiple
comparisons.
Results of these analyses found no significant outcomes
on the CDI. On the SCAS, however, there was a
significant Group Ă— Grade interaction, F(1, 193) =
9.25, p < .005, partial eta squared = .05. Simple effects
analyses of group differences within each grade level
demonstrated that there were significant intervention
group differences on the SCAS for Grade 6 students,
F(1, 96) = 7.48; p < .01. Grade 6 students within the intervention
condition scored significantly lower on the
SCAS (M = 9.53, SE = 0.88) across time compared to
Grade 6 students in the control condition (M = 17.07,
SE = 2.61). There were no significant intervention
group differences for Grade 9 students on the SCAS.
On the RCMAS, there was also a significant Group
Ă— Grade interaction, F(1, 193) = 8.63, p < .005, partial
eta squared = .04. Simple effects analyses of group differences
within each grade level demonstrated that
there were significant intervention group differences
for Grade 6 students, F(1, 96) = 4.43; p < .05. Across
time, Grade 6 students within the intervention condition
scored significantly lower on the RCMAS (M =
4.67, SD = 0.45) than Grade 6 students in the control
condition (M= 7.63, SD = 1.34). There were no significant
intervention group differences on the RCMAS for
the Grade 9 students. There was also a significant Time
Ă— Group Ă— Gender effect on the RCMAS measure of
anxiety, F(2, 386) = 7.37; p < .005, partial eta squared
= .04. To examine this interaction further, univariate
analyses were conducted separately for girls and boys.
Results revealed a significant Time Ă— Group interaction
for girls on the RCMAS, F(2, 186) = 4.07; p <
.04. Pairwise comparisons demonstrated that girls in
the intervention group scored significantly lower than
girls in the control group at 12-month follow-up, p <
.001, and 24-month follow-up, p < .05; however, girls
were not significantly different on RCMAS scores
across the intervention or control groups at 36-month
follow-up. There was no significant Time Ă— Group interaction
for boys. Table 2 presents the means and standard
deviations for all measures, across time, intervention
group, grade, and gender.
Discussion
This study examined the long-term prevention effects
of the FRIENDS program within the context of a
randomized controlled universal school-based prevention
trial. The FRIENDS intervention was offered to
both primary and secondary school students and was
evaluated against a control condition in Lock and Barrett’s
(2003) longitudinal study. This study aimed
to evaluate the longer term prevention effects of the
FRIENDS program across two grades, with long-term
follow-up data from 12-month, to 24-month, to 36-
month follow-up. It was anticipated that intervention
gains reported in Lock and Barrett would be maintained,
with students from within the intervention condition
self-reporting significantly lower scores on anxiety
and depression in comparison to the control
condition. Furthermore, it was expected that there
would be significantly fewer students within the highrisk
range on measures of anxiety and depression in the
intervention condition compared with the control condition.
Based on Lock and Barrett’s results, it was
further expected that there would be an Intervention
Group Ă— Grade effect, with students in Grade 6 reporting
more positive gains than students in Grade 9, and a
possible gender effect, with girls reporting the strongest
reductions in anxiety and depression.
The results of this study were generally supportive
of the study predictions. Consistent with Lock and
Barrett (2003), there was an Intervention Group Ă—
Grade effect, whereby students in Grade 6 appeared to
benefit more from the intervention than students in
Grade 9 on both measures of anxiety. For students in
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Grade 6, there were significant interventions group differences
at all time points across both the SCAS and
RCMAS, with students who received the FRIENDS
program reporting significantly lower anxiety scores
than students in the control condition. There were
no significant group differences for students in Grade
9. This finding strengthens Lock and Barrett’s suggestion
that intervening with prevention in Grade 6 may
be an optimal time for reducing risk for anxiety and
depression.
Consistent with Lock and Barrett’s (2003) study,
there was a significant Time Ă— Intervention Group Ă—
Gender effect; however, this was on anxiety (RCMAS)
only. Univariate analyses revealed that girls in the intervention
group scored significantly lower than girls
in the control group at 12-month and 24-month follow-
up; however, there were no significant differences
between girls in each group at 36-month follow-up.
This finding suggests that there is a prevention effect
for girls on anxiety symptoms up to 24-month follow-
up, however, this effect washed out by 36-month
follow-up for girls, who are more at risk for anxiety
than boys, based on the self-report measures of this
study.
Based on previous findings, it seems that gender
may play an important role in predicting both risk for
anxiety and intervention outcome. Results from Lock
and Barrett (2003) suggest that girls, across age
groups, tend to be at higher risk for anxiety than boys
but also tend to be most responsive to an intervention
up to 12-months follow up when the intervention is delivered
in Grade 6. This finding, taken together with
the results of this long-term outcome study, suggests
that intervening during primary school years can provide
very positive short-term outcomes for girls at a
universal level. However, given that being female is associated
with elevated anxiety and risk for anxiety, results
suggest that prevention programs need to be extended
across education, in that students—particularly
female students—receive such interventions every 2
to 3 years during their schooling. Results from the
Queensland Early Intervention and Prevention of Anxiety
Project (Dadds et al., 1997), which examined a targeted
intervention for high-risk and clinical students,
found that being female was a predictor for poorer response
to the targeted intervention. This finding further
highlights that female students are at higher risk and,
when experiencing subclinical and clinical levels
of anxiety (such as the sample examined in Dadds et
al.), school-based interventions may need to be coupled
with more intensive treatment interventions in the
community.
In terms of students at high risk (that is, elevated
scores on either the SCAS or CDI), there were proportionally
more students at high risk in the control condition
at each time point in comparison to the intervention
condition, and this effect was significant at
36-month follow-up. The frequency of students at high
risk in the intervention condition remained relatively
stable over time (i.e., 16%, 17%, 12%), whereas there
was a substantial increase in the frequency of high-risk
students in the control condition over time (i.e., 21%,
25%, 31%).
The results of this study did not demonstrate any
significant interaction outcomes for depression over
time. Examination of the depression means across gen-
409
UNIVERSAL SCHOOL-BASED ANXIETY PREVENTION PROGRAM
Table 2. Means and Standard Deviations for SCAS, RCMAS, and CDI Across Grade, Condition, Gender, and Follow-Up Point
CDI SCAS RCMAS
12 24 36 12 24 36 12 24 36
M SD M SD M SD M SD M SD M SD M SD M SD M SD
Intervention
Grade 6
Female 4.75 4.97 6.43 8.59 4.75 5.34 14.61 9.86 14.59 13.20 8.56 6.12 6.15 5.41 7.11 6.00 4.93 4.96
Male 5.68 5.72 6.81 7.36 5.44 6.16 10.51 10.30 10.52 13.37 6.81 8.72 4.95 5.29 4.65 4.97 3.52 3.80
Total 5.18 5.34 6.61 8.01 5.06 5.71 12.71 10.25 12.66 13.40 7.55 7.73 5.59 5.37 5.94 5.65 4.30 4.51
Grade 9
Female 10.72 8.12 9.97 8.75 7.63 5.31 21.36 13.04 21.35 17.77 17.09 12.92 10.95 6.52 8.63 6.18 8.14 5.99
Male 8.60 6.93 7.75 6.68 6.86 5.05 15.10 12.83 14.38 16.61 11.62 7.09 8.99 5.82 6.83 5.63 5.78 3.47
Total 9.76 7.66 9.03 7.99 7.38 5.21 18.54 13.28 18.37 17.56 15.14 11.45 10.06 6.27 7.87 6.00 7.37 5.40
Control
Grade 6
Female 7.69 6.78 7.96 7.23 8.14 6.16 20.75 12.78 16.48 11.94 21.50 4.95 9.92 5.79 7.42 6.85 7.57 4.20
Male 8.00 6.68 9.84 8.07 8.04 8.37 17.94 13.33 20.05 17.24 12.00 12.15 7.99 6.14 8.86 5.94 7.76 5.72
Total 7.86 6.70 9.08 7.74 8.08 7.57 19.23 13.10 18.61 15.31 13.46 11.74 8.88 6.03 8.30 6.30 7.69 5.17
Grade 9
Female 9.25 7.14 11.73 8.51 8.87 6.20 18.51 12.04 17.84 11.08 12.27 8.43 11.11 6.07 9.33 5.40 7.87 5.14
Male 9.13 8.01 7.82 6.66 8.94 6.89 14.33 11.34 11.02 10.04 14.19 18.99 7.99 6.04 5.88 4.50 7.32 6.65
Total 9.19 7.57 9.81 7.87 8.91 6.52 16.40 11.84 14.50 11.08 13.33 15.11 9.54 6.23 7.64 5.25 7.60 5.92
Note: SCAS = Spence Children’s Anxiety Scale; RCMAS = Revised Children’s Manifest Anxiety Scale; CDI = Children’s Depression Inventory.
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der and grade reveal consistently lower scores for children
in the intervention group in Grade 6 compared to
students in the control group; however, this trend was
not apparent within the Grade 9 cohort. Although these
results were not significant, they suggest that intervention
reduction in depression at 12-month follow-up
(see Lock & Barrett, 2003) may be maintained over
time.
This follow-up study provides evidence for the durability
of prevention effects for children who received
this program in Grade 6 up to 3 years following a brief
cognitive–behavioral intervention, delivered by classroom
teachers, within the school curriculum. For girls,
however, who reported the highest scores of anxiety at
preintervention and who reported the largest reductions
in anxiety up to 12-month follow-up (Lock &
Barrett, 2003), it seems that prevention effects are only
durable up to 24-month follow-up. Future research and
school-based prevention initiatives should aim to examine
a multilevel approach to prevention for children
and youth, such that universal prevention is coupled
with indicated programs for students at elevated risk,
effectively strengthening the dose of intervention and
potentially increasing prevention outcomes. Longterm
prevention outcomes would also be greatly improved
by maximizing booster sessions and ongoing
exposure to the life-skills taught in such a program,
whereby students are taught these skills throughout
their schooling from preschool through to primary and
high school. It would be of great interest and benefit to
examine whether prevention outcomes could be enhanced
for high school students if they were previously
exposed to these strategies during primary school.
This study is the first to present long-term outcomes
for a universal prevention program targeting anxiety
and associated depression. Strengths of this study that
serve to increase the generalizability of findings include
random assignment of schools to intervention
conditions, the presence of a control group, relatively
large sample size, intervention fidelity checklists, implementation
of an evidence-based protocol involving
students and parents, teacher delivery of the program,
and the use of highly reliable and valid measures of assessment.
These findings are limited due to the absence
of diagnostic data and the absence of multi-informant
self-report measures (i.e., teacher and parent report).
This study has provided evidence for the worth in
pursuing universal prevention in reducing the incidence
of anxiety and depression and the subsequent
burden of suffering associated with these disorders.
The development of a strong evidence base in treating
and preventing emotional distress is crucial. The
FRIENDS program has a promising evidence base at
every level of intervention—from treatment to universal
prevention. As highlighted by the WHO project
summary on the prevention of mental illnesses (Hosman,
2004), it is the political, ethical, and professional
obligation of policymakers, educators, researchers,
and consumers to persist with efficacy and effectiveness
research using evidence-based programs. Further
replication studies demonstrating efficacy of long-term
preventative outcomes are warranted and will assist in
driving effective prevention initiates and programs
such as the FRIENDS program into schools.
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Received December 21, 2004
Accepted March 6, 2006
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Paula Barrett,BSc (Hons), MCP,PhD,MAPS,

Posted on September 1, 2010 by admin

Paula Barrett,BSc (Hons), MCP,PhD,MAPS,

Professor Paula Barrett is one of Australia’s leading scholars in the area prevention and treatment of childhood anxiety disorders. Author of more than 160 articles in peer-reviewed journals, Professor Barrett served on the editorial boards of 7 international top rank journals. Her research is highly cited, and uses the highest quality research validation designs that are replicated internationally.

Paula’s FRIENDS for Life programs for the prevention and treatment of anxiety and depression in children, adolescents and adults are available in 12 languages and are used in 18 countries by: government departments for the education and health sectors, psychological and research-based clinics, academic institutions, and non-profit organisations.

Amongst other top-ranking international and peer-review journals, Paula’s research and programs have been cited in The Cochrane Collaboration and supported by the World Health Organization

Paula is also the Director of the innovative research-based clinic, Pathways Health and Research Centre. And is the patron of the Pathways to Resilience Trust that works to implement the Fun Friends and FRIENDS for Life programs in Australian schools in areas of low Socio-Economic Status, Culturally and Linguistically Diverse and Indigenous backgrounds, as well as regional and remote areas, particularly those affected by drought.

Recently, Paula received the Highly Commended Certificate, in the Human Rights Medal of the Australian Human Rights Commission, Telstra Queensland Business Woman of the Year Award 2008. In 2008 she has also been a finalist in the Australian of the Year Queensland Award, and the Queenslander of the Year Award, for her contribution to the well-being of children and to the community.

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