School-Based Treatment for Anxiety Research Study (STARS): a Randomized Controlled Effectiveness Trial

Area of Science:

• Child and Adolescent Psychiatry
• Clinical Psychology
• Educational Psychology

Background:

• Pediatric anxiety disorders are prevalent and impact academic and social functioning.
• School-based mental health services are crucial for accessible treatment.
• Cognitive Behavioral Treatment (CBT) is an evidence-based approach, but its effectiveness in school settings compared to treatment as usual (TAU) requires further investigation.

Purpose of the Study:

• To compare the effectiveness of school-clinician-administered CBT versus TAU for pediatric anxiety disorders.
• To evaluate treatment outcomes at post-treatment (12 weeks) and a 1-year follow-up.
• To identify potential moderators of treatment response.

Main Methods:

• A comparative study involving 216 students (ages 6-18) with primary anxiety disorders.
• Treatment was delivered by 62 school-based clinicians trained in either CBT or TAU.
• Outcomes assessed by independent evaluators included clinical improvement, global functioning, and diagnostic status; child and parent-reported anxiety symptoms were also measured.

Main Results:

• No significant overall treatment differences were found at post-treatment or 1-year follow-up on primary outcomes.
• Parent-reported child anxiety showed greater improvement in the CBT group (d = 0.29).
• Older youth, those with social phobia, and higher baseline anxiety were more likely to respond to CBT.

Conclusions:

• School-based CBT and TAU demonstrate comparable effectiveness for pediatric anxiety disorders.
• Parent-reported anxiety improvement favors CBT, especially for specific subgroups.
• Findings support the dissemination of CBT in schools, with considerations for specific populations.