Implementing school-based cognitive behavior therapy for anxiety in students with autism or suspected autism via a train-the-trainer approach: Results from a clustered randomized trial.
School staff can learn CBT in one workshop and then cut anxiety in autistic students without outside clinicians.
01Research in Context
What this study did
Reaven et al. (2024) tested if school staff can learn CBT for anxiety and then teach it to autistic students. They used a cluster RCT. Whole schools were assigned to CBT or usual care.
Staff attended a brief train-the-trainer workshop. Then they ran the 12-week Facing Your Fears program with students aged 8-14. Researchers tracked student anxiety and staff fidelity.
What they found
Students in the CBT group had much lower anxiety scores than peers who stayed in usual counseling. Staff kept good fidelity and their CBT knowledge rose.
The gains were large enough to matter in everyday school life. No extra clinicians were needed.
How this fits with other research
Subramaniam et al. (2023) ran a very similar CBT program in a hospital clinic. They saw only small, secondary gains. The key difference is setting: school versus clinic. Kids may practice coping skills more when they stay in the place that triggers anxiety.
Cox et al. (2015) showed that CBT anxiety gains can last over a year, but some symptoms creep back. Their earlier work supports the value of booster sessions after the 12-week cycle.
McGarty et al. (2018) warned that most autism studies are still done in preschool clinics. Judy et al. answers that call by moving CBT into elementary and middle schools.
Why it matters
You do not need to wait for outside clinicians. Train-the-trainer lets your own counselors, teachers, or BCBAs deliver evidence-based anxiety care during the school day. Pick one staff member, send them to the workshop, and start a small group this semester. Track anxiety with simple student self-scores and teacher checklists. You can expand the program once you see the first group succeed.
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02At a glance
03Original abstract
Autistic youth frequently experience anxiety that can negatively affect them at home, with friends, and at school. Autistic youth have difficulty accessing mental health care, and this is particularly true for youth from traditionally underserved backgrounds. Providing mental health programs in schools may increase access to care for autistic youth with anxiety. The purpose of the study was to train interdisciplinary school providers to deliver school-based Facing Your Fears, a cognitive behavior therapy program for anxiety in autistic youth. Seventy-seven interdisciplinary school providers across 25 elementary/middle schools were trained by their colleagues and members of the research (train-the-trainer approach). Eighty-one students with autism or suspected autism, ages 8-14 years, were randomly assigned to either school-based Facing Your Fears or usual care. Students in school-based Facing Your Fears showed significant reductions in anxiety compared to students in usual care according to caregiver and student report. Other measures involved examining change in provider cognitive behavior therapy knowledge after training and determining how well interdisciplinary school providers were able to deliver school-based Facing Your Fears. Results indicated that interdisciplinary school providers showed significant improvements in cognitive behavior therapy knowledge after training. Interdisciplinary school providers were able to deliver most of school-based Facing Your Fears activities and with good quality. The positive outcomes in this study are encouraging. Training interdisciplinary school providers to deliver school-based Facing Your Fears may increase access to care for anxious autistic students. Future directions and limitations are discussed.
Autism : the international journal of research and practice, 2024 · doi:10.1177/13623613231175951