J Clin Psychol. 2025 Nov 24. doi: 10.1002/jclp.70069. Online ahead of print.
ABSTRACT
BACKGROUND: Depression and anxiety are increasingly common among children and adolescents. While school-based cognitive behavioral therapy (CBT) is a promising intervention, most research has focused on its effects in high-risk or symptomatic populations. This leaves a critical gap in our understanding of its effectiveness as a universal prevention strategy for the general, low-risk student population. Establishing whether CBT can benefit low-risk students is crucial for developing proactive, school-wide mental health systems aimed at preventing future problems before they emerge. This study aimed to fill this gap by evaluating the short- and long-term effects of universal school-based CBT on low-risk children and young people, providing insights for optimizing intervention programs.
METHODS: Systematic searches of MEDLINE, Embase, the Cochrane Library, Web of Science, and PsyInfo were conducted from inception to January 15, 2025 to identify randomized controlled trials (RCTs) of school-based CBT for depression and anxiety in low-risk populations. Paired and regression meta-analyses of these results were conducted using Bayesian hierarchical models.
RESULTS: The 31 RCTs included a total of 19,865 children and young people. Compared to the control group, school-based CBT produced a statistically significant but very small improvement in depressive symptoms (SMD: -0.06, 95% CrI: -0.08 to -0.04) and a small reduction in anxiety symptoms (SMD: -0.19, 95% CrI: -0.22 to -0.17). These effects appeared to be maintained for up to 1 year. Exploratory analyses suggested that males may benefit more from anxiety interventions.
CONCLUSION: This study provides the first meta-analytic evidence that universal school-based CBT can produce small but durable, long-term preventive effects in low-risk youth. Although the very low quality of the underlying evidence means the findings are not robust enough to support widespread implementation at this time, they establish a crucial signal of effectiveness. The primary implication is that universal CBT is a promising strategy that warrants significant investment in future high-quality, large-scale trials to confirm its real-world value.
PMID:41277494 | DOI:10.1002/jclp.70069
