There is evidence to indicate that the FRIENDS intervention may reduce anxiety symptoms in children and adolescents when measured by children and adolescents themselves.
The review in brief
In this review, we aimed to find evidence of the effectiveness of the FRIENDS intervention, a cognitive behavioural therapy programme, on reduction of anxiety symptoms in children and adolescents. The evidence indicates that the FRIENDS intervention may reduce anxiety symptoms in children and adolescents when reported by children and adolescents themselves. There is also evidence to suggest that the FRIENDS intervention may increase the reduction in anxiety symptoms up to 12 months after the intervention.
What is this review about?
The intervention is three age-appropriate preventive anxiety programmes: Fun FRIENDS, FRIENDS for Life, and My FRIENDS Youth. Children and young people between 4 and 16 years of age who did not meet diagnostic criteria for an anxiety disorder diagnosis were eligible. The outcome of primary interest is anxiety symptoms.
What is the aim of this review?
We examine the effects of the FRIENDS preventive programme on anxiety symptoms in children and adolescents.
What studies are included?
Forty-two studies were identified. Only 28 were assessed to be of sufficient methodological quality and reported usable outcome data to be included in the data synthesis. Studies came from 15 different countries. The timespan of studies was 15 years, from 2001 to 2016. The average number of participants analysed was 240, the average number of controls was 212. The majority of studies were randomised controlled trials.
What is the effect of FRIENDS preventive programme on anxiety symptoms in children and adolescents?
Our results indicate that the FRIENDS intervention may reduce anxiety symptoms in children and adolescents when reported by children and adolescents themselves. On average, we found a positive, statistically significant effect in the short-term and at 12 months follow-up.
At follow-up, we found evidence that programmes implemented by mental health providers may perform better than programmes implemented by teachers.
What do the findings of this review mean?
We believe these positive average effect sizes are of a meaningful magnitude as the intervention was primarily given as a universal intervention, that is, to children and adolescents with no immediate anxiety problems.
The majority of trials employed a wait-list design, implying that only a few studies reported on the long-term effects of the FRIENDS intervention. Half the number of studies reporting post-intervention effects reported effects at 12 months follow-up, and even fewer reported on follow-up effects beyond 12 months. Our findings suggest that the FRIENDS intervention increases the reduction in anxiety symptoms up to 12 months after the intervention. This may have implications for practice, as there is a need to continuously evaluate the sustainability of treatment results and emphasises the need for future research not using wait-list design, so more follow-up effects are available.
The overall certainty of evidence varied from low to very low. Only one trial was rated low risk of bias on almost all domains. There is a need for more rigorously conducted studies.
How up-to-date is this review?
We searched for studies up to October 2023.