children and adolescents and to modifying lifestyle factors that have been associated with a range of MEB disorders. The programs described here are delivered across mental health, physical health, and school settings and have involved intervention directly with children, with parents, and with the whole family. The chapter closes with conclusions and recommendations based on the evidence presented in both Chapter 6 and Chapter 7.


Prevention of Anxiety

Anxiety symptoms and disorders typically emerge in childhood (see Chapter 2); lifetime rates of anxiety disorders by adolescence may be as high as 27 percent (Costello, Egger, and Angold, 2005). Anxiety disorders typically precede depression and may contribute to its development (Wittchen, Beesdo, et al., 2004). Although a number of studies have shown the effectiveness of cognitive-behavioral therapy (CBT) in treating anxiety disorders in children and adolescents (Barrett, 1998; Kendall, 1994; Kendall, Safford, et al., 2004; Manassis, Mendlowitz, et al., 2002; Mendlowitz, Manassis, et al., 1999), and there is some evidence of the benefits of anxiety prevention for college-age individuals with anxiety symptoms (Schmidt, Eggleston, et al., 2007; Seligman, Schulman, et al., 1999), relatively little research has been done on the prevention of these disorders. However, Bienvenu and Ginsburg (2007) recently reviewed evaluations of anxiety preventive interventions, most of which were conducted in Australia. All of the interventions are variants of CBT applied to prevention, and most involve parents in some way.

Rapee (2002) and Rapee, Kennedy, et al. (2005) report a selective intervention for 3- to 5-year-olds whose behavior was inhibited according to parent and child reports and a behavioral assessment. Parents were randomly assigned to a no-intervention control condition or to an intervention involving six 9-minute group sessions that taught them how to practice gradual exposure and techniques for dealing with different situations, such as entering school. At 12-month follow-up, the intervention group children had a significantly lower prevalence of anxiety disorders, although there was no effect on parental or maternal ratings of inhibition or inhibition as assessed through behavioral testing.

Barrett and colleagues conducted several studies of universal interventions to prevent anxiety problems among children and adolescents (Barrett, Lock, and Farrell, 2005; Barrett and Turner, 2001). The interventions consist of 10-12 classroom sessions and 4 parent sessions guided by a framework called FRIENDS: Feeling worried; Relax and feel good; Inner helpful thoughts; Explore plans; Nice work, reward yourself; Don’t forget to prac-

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