Cluster randomised controlled trial of the e-couch Anxiety and Worry program in schools

Background Anxiety is a common mental health problem in youth. The current study aimed to test the effectiveness of an online self-directed anxiety prevention program in a school-based sample and to compare two methods of implementing an anxiety program in schools. Methods A three-arm cluster stratified randomised controlled trial was conducted with 30 Australian schools. Each school was randomly assigned to receive: (1) externally-supported intervention, (2) teacher-supported intervention, or (3) wait-list control. All consenting students (N=1767) were invited to complete pre-intervention, post-intervention, 6- and 12-month follow-up questionnaires measuring generalised anxiety, social anxiety, anxiety sensitivity, depressive symptoms and mental wellbeing. Intervention participants completed the e-couch Anxiety and Worry program over 6 weeks. Results At post-intervention, 6- and 12-month follow-up no significant differences were observed between the intervention and control conditions for generalised anxiety (Cohen's d=-0.14 to 0.15), social anxiety (d=0.04-0.23), anxiety sensitivity (d=-0.07 to 0.07), depressive symptoms (d=-0.05 to 0.04) or mental wellbeing (d=-0.06 to -0.30). Limitations The current study only included self-report measures that may have been influenced by situational factors or biases. Conclusions The e-couch Anxiety and Worry program did not have a significant positive effect on participant mental health or wellbeing. The addition of a mental health education officer to support classroom teachers in the delivery of the program also had no effect on intervention outcomes. Future prevention research should look to develop briefer and more interactive interventions that are more engaging for youth.