Effectiveness of school group-based acceptance and commitment therapy for children with anxiety: a randomised controlled trial

INTERVENTION: Acceptance and Commitment Therapy group‐based manualised therapy program delivered by school counsellors formally trained in Proactive, at the child's school, as 10 x 1 hour sessions over 10 weeks, involving up to 8 children. Parents will have limited involvement. They will receive 2 sessions of 1. 5 hours duration coinciding with session 2 and session 7. The first session will be run by the school counsellors (psychologists trained in ProACTive who will be implementing the groups, using a Powerpoint presentation prepared by the CI. The first session involves psychoeducation around anxiety, ACT, and the ProACTive program. Parents receive a manual containing the information being presented in more detail. They will also have the opportunity to ask any questions relevant to their child's treatment. particular focus will be on parenting a child with anxiety, and how to ensure the skills being taught are generalised.. The 2nd session in week 7 will be conducted by the 2 CIs using a webinar format where parents across the various schools can interact live. Specific focus will be on understanding the upcoming exposure in‐session activities, and how to assist with generalisation. It will also be an opportunity to clarify any questions about the skills taught thus far, as well as trouble shooting generally issues that may be applicable across families. Parents will be asked to submit their questions prior to the webinar. The ACT program will involve the "Proactive" developed at The Children’s Hospital at Westmead, for children aged 7‐11 years and 12‐17 years, respectively. Groups will be run by 2 school counsellors who are psychologists formally trained in Proactive. Proactive has been empirically evaluated and found to be an effective treatment for children and young people with anxiety. This program incorporates all six ACT core therapeutic processes that target psychopathology including Acceptance, Being Present/Mindfulness, Valued directions, Committed Action, Self‐as‐context and Cognitive Defusion. Rather than focusing on symptom control, this program will concentrate on anxiety management via supporting children to identify what is important to them and get on with doing what they enjoy and is important to them, whilst encouraging acceptance of anxious thoughts and feelings that may arise in the process of doing so. Sessions involve Formal mindfulness practice is incorporated on commencement of each session. Psychoeducation (sessions 1and2) includes an adolescent‐adapted explanation of the ACT model via metaphor and experiential learning approaches. Values cards support understanding of the concept of living a valued life(session2). Defusion (getting some distance from difficult internal experiences) is taught via metaphors and experiential exercises (session 3 onwards). Graded exposure is undertaken using the ACT model whereby the act of confronting the fear is an exercise designed to enhance psychological flexibility, while the therapeutic procedure is what is performed in the presence of the feared situation . Specifically, emphasis is placed on supporting mindful observation and acceptance of anxiety while faced with fear in order to foster committed action in line with self‐identified values (from session 4 onwards). Finally, problem solving and social skills are incorporated to facilitate CONDITION: Anxiety in children and young people PRIMARY OUTCOME: Change in score on The Paediatric Anxiety Rating Scale (PARS)‐ clinician, child and parent rated Change in the Spence Anxiety Scale for Children (SCAS)‐ child and parent rated INCLUSION CRITERIA: 1) Aged between 7‐17 years 4) Have a parent/caregiver who is willing to attend and participate in the assessment as well as 2 parent sessions committed action. The skill of self‐compassion is specifically addressed during acceptance psycho‐education and in the final session where mindfulness activities using loving kindness are demonstrated. SECONDARY OUTCOME: Feasibility of running ProACTive in schools as measured by qualitative and quantitative therapist responses on the Feasibility Questionnaire Quality of life as measured by The Child Anxiety Life Interference Scale (CALIS)‐ child and parent rated 2) Meet criteria for a primary diagnosis of a Diagnostic and Statistical Manual of Mental Disorders (DSM‐IV) anxiety disorder (including panic disorder and/or agoraphobia, obsessive compulsive disorder, specific phobia, social anxiety disorder or generalised anxiety disorder) 3) Available/able to attend The Children’s Hospital at Westmead for pre‐treatment, immediate post‐treatment and six month post‐treatment assessments as well as attending a minimum of 80% of therapy sessions