For the first time, researchers have isolated the effects of anxiety prevention programs over intervention or treatment-based approaches for children and adolescents. Brian Fisak and colleagues from the University of North Florida report that anxiety prevention programs on average achieve a small but nevertheless significant effect on children’s outcomes (effect size = .18). Many child and adolescent prevention programs have demonstrated similarly ‘small’ effect sizes on a range of other outcomes; substance abuse programs for example are associated with effects of .05 to .20.

In mathematical terms, an effect size of .18 (meaning that the program has produced a one-fifth standard deviation improvement in outcome) is considered small. In human terms, however, small effects can have significant tangible consequences for children’s health and development. In the context of a prevention strategy, small effects are especially meaningful.

Fisak explains that “prevention programs have the potential to direct intervention groups into positive developmental trajectories. These positive trajectories may lead to increases in the differences between intervention and non-intervention groups over time”. Many of the participants in prevention studies have not yet developed anxiety problems and so it is not surprising that improvements immediately following an intervention may be minimal. It is highly likely that larger gains will be observed over the longer term and so longitudinal studies are fast becoming a priority for future research.

The Fisak review, is one of the first to synthesize the evidence relating exclusively to anxiety in children and adolescents and is the first to isolate the effects of prevention programs alone. Interest in prevention over the more traditional treatment approaches for dealing with childhood anxiety has gained momentum over the last ten years as a consequence of problems with retaining participants in treatment programs and high rates of relapse.

Anxiety typically develops in the early years and persists over time. As children get older it becomes more difficult to change the maladaptive thoughts and behaviors that underpin many symptoms of anxiety. As Fisak puts it, many children with anxiety problems become treatment-resistant. Prevention strategies on the other hand are designed to inhibit the onset of symptoms in the first place and the meta-analysis reveals that universal prevention programs are particularly effective.

The findings of the review reveal that children and adolescents benefit from prevention programs regardless of their risk status; both children described as high risk and those labeled low risk experienced a reduction in their anxiety levels. Fisak explains that these types of programs typically impart skills for dealing with anxiety, fear and stress responses, all of these things are considered normative challenges within childhood. Thus, all children benefit.

Many of the programs included in the review were modeled on the principles of cognitive-behavior therapy (CBT). This is an umbrella term for a wide range of therapeutic techniques the fundamental premise of which is that behavior and feelings can be modified by altering patterns of thinking. Children who tend to overestimate the probability of unlikely but harmful events, and generally feel unable to cope with challenging or demanding environments, are at high risk of developing anxiety problems. CBT approaches teach children to anticipate typical reactions to a given situation and be prepared to counter them with a more rational and adaptive response.

The reviewers highlight one such program - FRIENDS - as a particularly effective service. FRIENDS is a manualized universal prevention program that can be easily integrated in school curricula. (See: When prevention is the only way — as well as the best).