Running head: SCHOOL-BASED ANXIETY INTERVENTIONS

School-Based Anxiety Interventions:

A Literature Review
Laura Witt
Millersville University

SCHOOL-BASED ANXIETY INTERVENTIONS

Abstract
Anxiety is an issue that plagues countless school-aged youths, and because of this it is
essential for school counselors to have the capacity to facilitate interventions that focus on the
support and remediation of these symptoms within student populations. As a result of their wideranging usage, the cognitive-behavioral and solution-focused counseling orientations can provide
counselors with this capability. The following research provides a framework for facilitating
these types of counseling groups to elementary students, while also acknowledging an overview
of the issue, the function of the school counselor, and the role of the American School Counselor
Association in regard to programmatic implications.

SCHOOL-BASED ANXIETY INTERVENTIONS

School-Based Anxiety Interventions:

A Literature Review
Anxiety is an issue that continuously affects innumerable school-aged children (The
Mayo Clinic, n.d. a: Muris, Merckelbach, Mayer & Prins, 2000). For this reason, it seems that
school counselors will inevitably encounter this issue at some point during the span of their
careers, and will then be faced with making decisions regarding interventions that aid students
who are afflicted by anxiety. However, group counseling, as it provides many efficient
components that frequently aid students (American School Counselor Association, 2014), may
offer counselors a unique and efficient sense of service toward this population. Furthermore, the
solution-focused and cognitive behavioral theoretical orientations also have proven to be very
effective counseling frameworks (Henderson & Thompson, 2011), which may likewise
successfully serve students with anxiety. It seems that if combined, these theoretical orientations,
as well as associated programs, can mold a highly advantageous group intervention that
successfully supports elementary students. It is essential for this population to have access to this
type of remediation, as this age group presents a unique sensitivity to anxiety issues (Bittner,
Egger, Erknali, Costello, Foley & Angold, 2007; DeSocio & Hootman, 2004; Miller, et al, 2010).
Background/Overview of Issue
Anxiety is defined as a sense of strong, unwarranted and incessant worries, which often
involves situations and concerns that are commonplace in the life of the worrier. Frequently, this
feeling results in a multitude of intense emotions that can consequently be difficult to control.
Symptoms that relate to anxiety issues often begin during adolescence, with occurrence rates
varying between 10% and 20%, and progress overtime (Dadds, Spence, Holland, Barret &
Laurens, 1997; Muris, Merckelbach, Mayer & Prins, 2000, as cited in Miller, Short, Garland &

SCHOOL-BASED ANXIETY INTERVENTIONS

Clark, 2010). The National Institute of Mental Health (2013a) goes on to report that up to 8% of
adolescents within the age range of 13-18 have been diagnosed with an anxiety disorder.
However, it is also common for symptoms to begin to persist at around age six in the majority of
these individuals (as cited in Allison, Nativio, Mitchell, Ren & Yuhasz, 2014).
Thisprevalenceispossiblysohighbecauseanxietyisaninnatecomponentofawide
arrayofmentalhealthdisorders,suchasobsessivecompulsivedisorder(OCD),phobiasand
generalizedanxietydisorder(GAD)(Allison, et al., 2014).Otherrelatedconditionsinclude
separationanxietydisorder,panicdisorderandsocialanxiety(TheMayoClinic,n.d.b).As
statedpreviously,suchconditionsaregenerallycharacterizedwithfeelingsofdistressand
uncertainty.However,thesestressfulsymptomsareunliketypicalanxiety,whicharecausedby
arbitraryevents.Thefearsassociatedwithclinicalanxietypersistovertimeandcanoftenworsen.
Inessence,thougheachtypeofanxietyissuehassymptomsuniquetoitsrespectivecondition,all
arecommonlymarkedwithpersistentandillogicalfears,aswellasacommonsenseofdread
(Allison, et al., 2014).
Anxiety issues also typically involve a wide array of physical and psychological
symptomology. Notably, anxiety has been proven to provoke several somatic symptoms in those
who suffer from it. These can include an increased heart rate, hyperventilation, perspiration and
physical shaking. However as a predominant mental health disorder, the condition also induces
emotional symptomatology, such as nervousness, feelings of dejection, and an inability to
concentrate (The Mayo Clinic, n.d. b). Moreover, Bell-Dolan, Last and Strauss (1990) cited that
anxious children often display higher rates of depression, loneliness and stress than non-anxious
children. Based on all of these very serious manifestations, it seems imperative for students to
have access to services that relieve these critical issues.

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Forchildren,thesesymptomsbecomeasignificantconcernwhentheyinterruptthe
normalprogressionofdevelopment(Kendall,Chansky,etal.,1992,ascitedinKendall,1994).
Inaway,thepervasivenessandseverityofanxietyindicatestheimportanceofstudentsto
receivehelpfortheirsymptomsatanearlyage.Itseemsthatstudentshavingtheabilitytoattain
accessibleservicesfortheseissueswouldprovidethemwithanexceptionalsenseofsupportand
renewal.Forthesereasons,schoolcounselorsmayprovideauniquesupportsystemforstudents
whosufferfromanxiety,astheyaretypicallyhighlyaccessibleandhospitabletostudentgroups.
Future psychological concerns further prove the severity of this issue and advance the
need for school counselors to work to remediate the current anxiety symptoms of their students.
Bittner, Egger, Erknali, Costello, Foley and Angold (2007) surveyed the pervasiveness of anxiety
disorders during childhood and the persistence of these symptoms later in life. The authors cited
that childhood separation anxiety disorder forecasted the prevalence of this condition as the child
ages. Additionally, overanxious disorders during childhood correlated with anxiety issues later in
life, as well as depression, conduct disorder and panic attacks during adolescence. Furthermore,
childhood generalized anxiety disorders also predicted the development of future conduct
disorders, while childhood social phobias were associated with attention deficit/hyperactivity
disorder, overanxious disorders and social phobias overtime. It seems that if these issues are not
remediated when they initially occur, such symptoms may continue or even worsen. In essence,
all of these rates evidence how severe the prognosis of anxiety can be, and emphasize the need
for children to access help for these issues from those around them, which often includes school
counselors.
Moreover, anxiety related conditions are not only damaging to an individuals physical
and psychological state but can also harm many contextual aspects of life, including the

SCHOOL-BASED ANXIETY INTERVENTIONS

possibility of academic achievement. For instance, DeSocio & Hootman (2004) reported the
negative influence that the manifestation of anxiety disorders can have on the learning process.
This effect occurs because the relationship between education and mental health is reversible.
Essentially, children who have been diagnosed with a mental health disorder are at an advanced
risk of poor school performance, while students who struggle with academics often have a higher
chance of developing certain mental health issues (Dweck & Wortman, 1982, as cited in Kendall,
1994). Therefore, this correlation evidences the strong relationship between the education system
and mental health. Meaning, school-based settings seem to be extremely appropriate
environments in which counselors can support students who suffer from mental health issues,
which include anxiety. It appears that by working with students to overcome their anxiety in this
way, counselors not only help students to toil through their psychological symptoms, but also
give them a means to improve their academic standing as well.
Along with academic difficulties, the persistence of anxiety can also deter many other
aspects of a childs personal life. Researchers have found that parents are often overwhelmed as
they try to care for anxious children, while schools also become easily frustrated with the
behavior and attendance issues of these students. It is common for these occurrences to take
place because externalized symptoms of anxiety can negatively manifest in both school settings
and at home (Miller, Short, Garland, & Clark, 2010). Wagner (2005) also cited that this may
occur because parents and teachers often misconstrue a childs anxiety-related behavior as
irritating, attention-seeking and even devious, which can then cause a discord in these
environments (as cited in Hanie & Stanard, 2009). These symptoms can in turn be generalized to
affect the students entire life and loved ones, as parents are frequently blamed for these
behaviors, which additionally facilitates detrimental family dynamics (Miller, et al., 2010). It

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seems that all of these negative social consequences exemplify how damaging anxiety disorders
can be, and present a need for effective interventions. This further evidences the importance of a
school counselors work to help students to overcome these symptoms, as they can affect every
facet of their lives.
As a result of the prevalence of anxiety issues, it is essential for counselors to be enabled
to work with student populations who suffer from forms of these symptoms. Stemming from
their inherent effectiveness, group counseling services may be among the most appropriate
approaches to carry out such interventions. The American School Counselor Association (2014)
stated that through group processes, students can develop newfound understandings of
themselves and others. However, groups are also highly efficient because through them,
counselors become permitted to serve a greater number of students, rather than working with one
student at a time.
The general effectiveness of groups was acknowledged by the Association of Specialists
of Group Work (2000), who stated that guidance groups emphasize the development of important
skills, problem-solving, coping strategies and decision making, which prevent the growth and
manifestation of the presenting problems that plague group members (as cited in Gerrity &
DeLucia-Waack, 2007). In regard to specific anxiety groups, Barrett (1998), and Cobham,
Dadds, and Spence (1998) consistently confirmed that children who attended cognitivebehavioral anxiety groups demonstrated a vast decline in these symptoms following the
culmination of the program (as cited in Thompson, Robertson, Curtis, & Frick, 2013). For all of
these reasons, it appears that groups have a unique place within the school counseling field and
the ASCA National Model, and may be especially useful for counselors to utilize when working
with students with anxiety.

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Theoretical Background
School counselors typically counsel students in the perspective of a certain theoretical
orientation that most applicably fits their practical style. As there are so many existing and
empirically researched approaches to counseling, it seems that many would potentially be
appropriate for counselors to use when working with students with anxiety. However, research
has demonstrated that countless anxiety interventions closely accord to cognitive-behavioral
techniques (Kendall, 1994; Lowry-Webster, Barrett, & Dadds, 2001; Misfud & Rapee, 2005),
while the solution-focused approach is a popular orientation for school counselors to utilize
when working with students in general (Brasher, 2009). Therefore, because of the extensive use
of these approaches, both seem to have the potential to generate positive results when working
with populations of elementary students with anxiety.
Cognitive Behavioral Orientation
As stated previously, it seems that the most prevalent theoretical background for anxietybased interventions revolves around the cognitive-behavioral theoretical orientation. This
perspective views an individuals behavior as a direct result of their potentially negative
cognitive processes, which are in turn influenced by the social and biological forces that
surround them (Beck & Weishar, 2008, as cited in Henderson & Thompson, 2011). Through this
viewpoint, mental illnesses are also thought to be the result of factors such as illogical beliefs or
misconceptions of events that take place (Beck, 1995, as cited in Henderson & Thompson).
Psychological interventions then become necessary when this illogical thinking impedes an
individuals life, and triggers the development of issues, such as anxiety. In essence, Henderson
and Thompson (2011) synthesize that negative cognitive processes influence the development
and onset of these issues, while counselors work to reverse these detrimental ideas through

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helping the client to learn to problem solve, develop coping skills or restructure their thoughts.
This would then allow clients to view situation in a more rational and positive light, which would
then enable them to respond to such situations with a logical manner.
The most central element of this theory is the notion of cognitive processes having a
direct effect on an individuals perceptions and subsequent behavior (Henderson & Thompson,
2011). However, as anxiety and behavior are highly interrelated (DeSocio & Hootman, 2004;
Miller, et al., 2010), it seems that by challenging the highly negative thoughts that relate to
anxiety, counselors can work with their clients in order to facilitate a more beneficial style of
thinking. Ybaez-Llorente (2014) reinforced the importance of cognitive processes within
counseling by stating that individuals who suffer from anxiety are in constant alert of potential
danger. However, attuning to more positive thoughts allows anxiety sufferers to understand that
these ideas are impairing their entire being, while learning to reverse them as a result. In essence,
the premise of the cognitive behavioral orientation appears to be essential in resolving anxiety
issues, which provides counselors with innovative methods to utilize when counseling these
populations.
In working within this orientation in counseling groups, this approach would be applied
by challenging the anxious thought processes of group members, while also enabling participants
to benefit from the advantageous functions of group counseling (American School Counselor
Association, 2014; Gerrity & DeLucia-Waack, 2007; Thompson, Robertson, Curtis, & Frick,
2013). This provides counselors with a unique perspective regarding anxiety groups, which may
in turn facilitate valuable remediation for these student populations. It seems that when
collaboratively applied, both of these elements of counseling would shape an efficacious form of
delivery.

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Solution-Focused Counseling
As a result of its brief and adaptable characteristics, solution-focused techniques are often
extensively employed by many practicing school counselors (Brasher, 2009). This orientation
emphasizes a clients strengths and past successes in order to enable the client and counselor to
work together to elicit potential solutions to the clients presenting issues (Lethem, 2002).
George, Iveson and Ratner (2000) synthesized the main premises of this theory, which include
ideas such as understanding that the cause of an issue is not essential to recovery, successful
counseling is contingent on the clients progress and future goals, and regardless of how constant
an issue appears to be, instances of clients practicing potential solutions must always inherently
exist. Furthermore, through this theoretical lens, problems are believed to not exclusively
represent a clients inherent pathology, small changes are thought to initiate greater solutions to
the general issue, and counselors are also considered to be responsible for discovering ways in
which clients can successfully collaborate with the counseling process (as cited in Lethem,
2002).
The constructiveness related to this approach is also thought to inspire clients to make
necessary changes in their behavior through practice and homework tasks that are cooperatively
assigned by the counselor and client. Counselors frequently utilize solution-generating
techniques such as the miracle question, which allow clients to visualize their ability to
overcome their presenting issue and describe how their life would be better if the issue that they
are facing were solved. Scaling techniques are also often used to allow clients to appraise their
development and assess their progress toward their goals (Henderson & Thompson, 2011; Kim
& Franklin, 2015). The extensive solution-oriented elements of this orientation provide clients

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with tangible perspectives of their presenting problem, which then facilitates a development
toward recovery.
The positivity associated with solution-focused counseling is a major strength of the
entire approach. According to Fitzpatrick and Stalikas (2008b), most theoretical orientations
view positive emotions as the desired outcome for counseling processes. However, most lack the
notion that these feelings can be a source for change to occur (as cited in Kim & Franklin, 2015).
De Shazer (1985) went on to demonstrate that positive feelings are vital components of
counseling itself and can lead to a clients general healing (as cited in Kim & Franklin, 2015).
This idea was further echoed by Henderson and Thompson (2011), who stated that counselors
with this orientation believe that mental health issues arise from an individuals negative
worldview, and can be corrected through improved beliefs and behavior. Therefore, the solutionfocused orientation offers benefits for students that other theories do not, making it an extremely
operative approach for counselors to utilize.
Based on the work of Ybaez-Llorente (2014), it seems that individuals who suffer from
anxiety lack the positive outlook that solution-focused practitioners deem essential to mental
health (Kim & Franklin, 2015). Therefore, these negative perspectives may lead to the
development and abatement of this issue. However, when exposed to the solution-oriented
counseling interventions that accord with this approach, it seems that clients will be able to
utilize the constructive techniques within it, such as the miracle question, scaling, etc., to view
their symptoms in a more optimistic light. This may in turn contribute to the expansion of
positive coping techniques and general mental health. When utilized in anxiety group
interventions, participants could be ameliorated from the utilization of techniques that prescribe
solutions to their presenting issues and tangibly resolve their anxiety symptoms as a result.

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Empirical Evidence of Groups & Programs

As anxiety disorders are so widely prevalent among children and adolescents, this topic
has been widely researched within many empirical studies. Furthermore, many school-based
anxiety programs have been peer-reviewed within a modern literature base and fundamentally
tied to the cognitive-behavioral theoretical orientation. These provide evidence for the
effectiveness of anxiety groups, as well as pose an of outline prevention, intervention and
postvention techniques related to this counseling approach and this issue. However, though
limited in number, some research has been conducted on solution-focused interventions, which
provides some sense of cognizance for utilizing this orientation within elementary student
populations.
The Coping Cat Cognitive-Behavioral Program
TheCopingCatprogramisacognitivebehavioralgroupbasedinterventionthataimsto
aidchildrenwhosufferfromanxiety(Kendall,1994).Thisinterventionincorporatesseveral
differentobjectives,suchashelpingparticipantstounderstandtheirreactionstotheiranxiety
symptomsandfullycognizetheirthoughtsandemotionsinanxietyinducingcircumstances,
whilealsoacquiringtheabilitytoeffectivelycopewiththeirstressandassesstheirprogressin
doingso.Theseobjectivesareexemplifiedinmanydistincttechniques,suchaspsychoeducation,
exposuretasksandsomaticmanagement,allofwhichteachrelaxation,cognitiverestructuring
andproblemsolving(TheCaliforniaEvidenceBasedClearinghouseforChildWelfare,n.d.a;
Kendall,1994).

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TheseideasaretaughtwithinFEARplan,whichisanacronymusedtoallowitsyouth
participantstounderstandthevariousfeaturesoftheanxietythatplaguesthem.Throughtheuse
ofthismemorytool,participantsbecomeenabledtounderstandwhentheyarefeelinganxious
andrecognizetheirexpectationsforthisstress.Subsequently,studentsallowthemselvesto
employpositiveattitudesratherthananxietyriddenones.Furthermore,participantsalsolearnto
understandtheresultsofthecognitivechangesthatsurroundtheiranxietyandthenpractice
rewardingthemselvesaccordinglyinrealworldsettings.Thispromotestheutilityofthese
newfoundskillsetsinactualsituationsandempowersparticipantstorecognizetheircoinciding
progress(Podell,Mychailyszyn,Edmunds,Puleo&Kendall,2010).
TheFEARplanistaughtduringthepsychoeducationportionsoftheprogram,inwhich
participantsapplytheirnewlylearnedskillstoananxietyhierarchyandallowthemselvestocope
withmorestressfulsituationsovertime.Indoingthis,studentsrecognizeandunderstandtheir
anxietyandthenworktodiminishitasaresult.Duringitsconcludingsessions,participants
presenttheskillsthattheyhavelearnedfromthisprocesstotheentiregroupinanattemptto
finalizetheirentiregrowth(Podell,Mychailyszyn,Edmunds,etal.,2010).Inthisapproach,
studentsareeventuallyenabledtorewardthemselvesfortheprogressthattheymakethroughout
theprogram.Theserewardsareselfdistributedonthebasisofefforttowardmakingprogress
withinassignedhomeworktasks,ratherthanonperfectionormasteryofskills(Beidas,
Benjamin,Puleo,etal.,2010;TheCaliforniaEvidenceBasedClearinghouseforChildWelfare,
n.d.a).
Additionally,participantsgenerallybecomeenabledtodifferentiatebetweenthesomatic
symptomsthataccompanyanxietyandthatofotheremotions.Indoingthis,thegroupleader

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givesparticipantsexamplesofsymptomsthatfrequentlyaccordwithanxiety,whilealso
presentingtheideasoffalsealarms,inwhichanindividualmayfeelanxiousduringunfitting
circumstances.Thisultimatelyallowsparticipantstorecognizeandpreventfutureunseemly
occurrencesoftheseemotions.Bodydrawingactivitiesarealsoutilizedduringthisprocess,in
whichthegroupdescribestheirsomaticresponsesthroughpictures,whilelearningtoeasethem
bymeansofrelaxationtechniquessuchasdeepbreathing(Beidas,Benjamin,Puleo,Edmunds
&,Kendall,2010;Podell,Mychailyszyn,Edmunds,etal.,2010).Withinthissomatic
recognition,studentsbegintomorefullyunderstandtheiranxietiesandthethoughtprocesses
associatedwiththem.
Incognitivebehavioralform,participantsaresubsequentlytaughthowtheirnegative
selftalkorexpectationsmaybeworseningtheiranxiety.Indoingthis,theparticipantsand
facilitatorworktogetheronanactivitytocreatecartoonswiththoughtbubblesthataccompany
ambiguoussituations,whichmaybeeitherstressfulorbenigntoeachchild.Thisallows
participantstoviewhownegativethoughtscandrasticallyworsentheirsymptomsandoutlook.
(Podell,Mychailyszyn,Edmunds,etal.,2010).Participantsarealsotaughttoformnewattitudes
thatmaybenefittheiranxioustendencies.Forinstance,studentsareshownthatpotentialstresses
areapartofeverydaylife,andtoconsequentlyunderstandhowtodecreasethesereactions.
Throughthis,thefacilitatorandparticipantsfrequentlyproducealistofgeneralsolutionsto
anxiety,whilealsocreatingpossiblereasonableandunreasonableresolutionstostressful
situations(Podell,Mychailyszyn,Edmunds,etal.,2010).Indoingthis,groupmemberscan
distinguishandimplementpositivethoughtprocesses,whilerelinquishingtheirpredisposed
negativeones.

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Modulesofthisapproachtakeplacewithin16weeksofgroupmeetings,andwith45
childparticipantswithinthegeneralagerangeof713ineachgroup.TheCopingCatprogramis
alsocharacteristicallyconductedwithinawidearrayofmentalhealthsettings,whichoften
includesschoolcounseling(TheCaliforniaEvidenceBasedClearinghouseforChildWelfare,
n.d.a;Kendall,1994).Resultsofthisinterventionhaveprovenitgenerallyeffectiveimmediately
followingtheinterventionandoneyearafteritscessation.Thiseffectivenesswasconfirmedby
ratingsfromparentsandstudents,whichseemstoindicateasenseofuniversalityinperceptions
ofitsefficacy(Kendall,1994).Asaresultoftheseevaluations,itisapparentthatthisprogramis
highlyapplicabletostudentswhosufferfromanxietyconditionsandconsequentlymaybean
operativeschoolcounselingtechnique.
TheCoolKidsProgram
The Cool Kids Program is a group-based intervention program that can be administered
to small groups of students within a school setting, in order to reverse the symptomology of
anxiety issues (Rapee, Wignall, Hudson, & Schniering, 2000, as cited in McLoone, Hudson, &
Rapee, 2006). The program informs students within the ages of 7-17 of how to better manage the
anxiety issues that afflict them. This process occurs over a period of eight one-hour weekly
sessions, and culminates with 2 two-hour bi-weekly booster sessions. (TheCaliforniaEvidence
BasedClearinghouseforChildWelfare,n.d.b). The programs core objectives are to eradicate
the anxiety symptoms of its participants, as well as decrease their avoidance and family-induced
stress levels. This intervention also seeks to develop a participants confidence, peer relationships
and extracurricular involvement, all of which may be hindered by their preceding anxiety (The
CaliforniaEvidenceBasedClearinghouseforChildWelfare,n.d.b;McLoone,etal.,2006). In
essence, while eliminating the cognitive and behavioral processes that drive anxiety, this

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program also focuses on altering the inherent behavior of its participants.

In doing this, the programs curriculum includes counseling sessions that focus on
psychoeducation about the nature of anxiety symptoms, cognitive restructuring that confronts
anxious thoughts, as well as exposure experiences through the use of anxiety hierarchies. Other
components include social skills training, with lessons of how to overcome teasing and build
assertiveness, or exercises that are meant to improve coping skills. These activities allow
students to solely develop only positive mechanisms for handling their anxiety and release their
innate negative ones (TheCaliforniaEvidenceBasedClearinghouseforChildWelfare,n.d.b;
McLoone, et al., 2006). At the culmination of the program, McLoone, et al (2006) states that
participants should be better enabled to manage their anxiety symptoms, face previously feared
situations with little apprehension, and independently progress through these profound activities
without the help of their parents or the counselor.
To fulfill the familial support variable of the curriculum, the counselor also typically
holds meetings with parents that promote their involvement in facilitating their childs
improvement. In doing this, parents become enabled to mange their childs anxious emotions and
lessen their need to control their childs behavior (TheCaliforniaEvidenceBasedClearinghouse
forChildWelfare,n.d.b; McLoone, et al, 2006; Misfud & Rapee, 2005). Students are
subsequently assigned weekly homework tasks that allow them to practice the objectives that are
learned during group sessions in their everyday life. Yet as a result of these parent meetings, the
parents of participants can also facilitate these activities themselves, to further encourage better
developed skills and coping (TheCaliforniaEvidenceBasedClearinghouseforChildWelfare,
n.d.b). These activities directly allow students to turn their newly learned cognitive processes
into everyday behaviors, which then works to eliminate their anxiety entirely.

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Generally, when researched in a school counseling environment, students who were

exposed to this program exhibited a significant improvement in anxiety symptoms after its
conclusion. For instance, Misfud and Rapee (2005) demonstrated that with a group of students of
low socioeconomic status, participants showed substantial rates of decline in both anxiety
symptoms and anxiety-inducing beliefs, which include thoughts related to impending failure and
other similar threats. These evaluations were further supported by the reports of the parents and
teachers of participants, who also indicated noticing such a decline in symptoms. This
effectiveness was also sustained in long-term contexts, as positive results were maintained for up
to four months postvention. This empirical information seems to prove the validity of this
intervention in a school counseling environment, which evidences its universal utility for those in
this field.
Friends for Life Cognitive-Behavioral Program
The Friends for Life program is a universal prevention guidance curriculum that focuses
on anxiety. Meaning, this program aims to help its participants to avert the onset of these
symptoms both currently and later in life (Barret & May, 2007). In doing this, its objectives
works to enhance a childs resilience to anxiety irrespective of their inherent vulnerability to this
issue, while also avoiding further stigmatization for those who may suffer from these conditions.
As a universal program, it also works to increase peer support among participants in order to
raise a sense resiliency in this population (Lowry-Webster, Barrett, & Dadds, 2001). Finally, in
order to tangibly allow this to occur, the program focuses on the physiological, cognitive and
behavioral processes that contribute to the development, experience and abatement of anxiety
(Barret & May, 2007).
This intervention takes place over ten weekly sessions within a school setting. Most

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prominently, these sessions take place within a classroom-based guidance curriculum to a

general population of students as a part of a comprehensive guidance program. The program also
includes three booster sessions one month following its culmination to reinforce the students
understanding and use of its core objectives. Finally, parent sessions are also included, in order to
enable parents to work with students to practice the skills that students have learned outside of its
guidance setting (Lowry-Webster, Barrett and Dadds, 2001).
Its specific interventions center on cognitive restructuring in stressful situations, which
teaches students to better cope with their experienced anxiety (Lowry-Webster, Barrett, & Dadds,
2001). This program also advocates for and enhances a childs ability to utilize and reinforce
positive self-talk as a coping mechanism for such issues. Other core objectives focus on
relaxation and exposure techniques, as well as advocating for a students individual strengths to
deter anxiety manifestations (Rose, Miller &Martinez, 2009). Through these mechanisms,
participants are enabled to include physiological, cognitive and behavioral coping strategies into
their daily life in order to more effectively manage the anxiety that plagues them (LowryWebster, Barrett, & Dadds, 2001).
Though this program typically takes place within a guidance curriculum, its empirically
proven effectiveness seems to provide a model of techniques that can transpire in other delivery
services. These results are highly efficacious, as outcomes of this program have proven to be
highly successful. For instance, Lowry-Webster, Barret and Dadds (2001) demonstrated
promising outcomes for this program in both participants who had clinical levels of anxiety and
those who did not. In essence, all students who had experiences with these techniques reported
lower rates of personal anxiety. Rose, et al. (2009) also went on to prove the general
effectiveness of this program post-intervention. However, it was additionally demonstrated that

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this program fosters important training to sensitize classroom teachers about anxiety issues,
which can consequently work to aide the psychosocial needs of students. Meaning, in expanding
this approach to a school setting, it seems that its objectives can be greatly beneficial to teachers
and students alike. These results remained consistent among participants up to one year
following the program (Essau, Conradt, Sasagawa, & Ollendick, 2012), further proving its
general effectiveness in both long-term and short-term contexts.
Solution-Focused Techniques
As stated previously, solution focused techniques are often used by school counselor as a
result of their brevity and overall effectiveness (Brasher, 2009). This orientation has been
successfully used in school-based counseling groups to remediate many issues that affect
students, such as academic performance and behavioral issues (Fearrington, McCallum &
Skinner, 2011; Vallaire-Thomas, Hick & Growe, 2011). The efficacy of this technique was
further explored by Franklin, Biever, Moore, Clemons and Scamardo (2001). These researchers
facilitated a solution-focused group for an assemblage of nineteen 5th and 6th graders for a series
of 5 to 10 group counseling sessions. These students were referred as a result of learning or
behavior problems, which encompassed anxiety issues for some. While conducting this group
counseling process, researchers facilitated the group with several common solution-focused
interventions, such as the miracle question, scaling and other homework activities
Resultsofthisinterventionwereproventobegenerallyeffectivefortheinnumerable
conditionsthatitsstudentparticipantspresented.Theauthorsparticularlynotedthecaseofone
studentincludedinthegroup,whowasreferredtotheprogramasaresultofseveralbehavioral
andacademicissues,andhadbeenpreviouslydiagnosedwithgeneralizedanxietydisorder.After
theterminationoftheintervention,bothmentalhealthprofessionalsandteachersreportedthe

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studenttohavefewerbehavioralandsocialdeficits(Franklin,etal,2001),provingthepotential
effectivenessofthisframeworkwhenservinganxiousstudentpopulations
Research Gaps.
The work of Franklin, et al (2001) provides some evidence toward the effectiveness of
the solution-focused orientation within the results of the student noted above. However, this
reliability is greatly limited as its effectiveness is based only on one student and the orientations
direct result on anxiety symptoms lacks definitive clarity. Moreover, as this orientation is
ultimately widely used by many practicing school counselors (Brasher, 2009) and has been
empirically proven to successfully aid the presenting issues of many students (Fearrington,
McCallum & Skinner, 2011; Vallaire-Thomas, Hick & Growe, 2011), it seems that it also has the
potential to adequately serve populations of students with anxiety.
Unfortunately, modern empirical literature entirely excludes descriptions of concrete
solution-focused methods that focus on reducing anxiety symptoms. This is potentially a
consequence of the newness of this approach and the inability of counselors to clearly define a
clients presenting issue or results, which stems from its collaborative nature (Kim, 2008).
Therefore, by utilizing this novel approach, along with the successfulness of the cognitivebehavioral orientation, facilitating a group counseling process that is directed at anxiety within
this orientation could provide a new set of information for this topic, allowing its successful and
evidence-based usage in the future
Conclusions about Prevention, Intervention and Postvention Techniques
The aforementioned counseling programs and theoretical orientations pose many
consistent themesamongthem.Thesepremisesandconclusions,whichwerealsoproventobe
empiricallysuccessful,provideoutlinesforworkingwiththedescribedpopulationofelementary

SCHOOL-BASED ANXIETY INTERVENTIONS

21

studentswithanxiety.Asaresult,itseemsthatcounselorscanusethesemodelsassound
examplestobasetheirowncounselingmethodsandinterventionsupon.Therefore,asaresultof
theaboveresearch,extensiveconclusionsregardingprevention,interventionandpostvention
techniquescanbedrawntoefficaciouslyserveanxiousstudentpopulationswithingroup
counselingcontexts.
Copingmechanismsarecrucialskillsetsthatareoftensuccessfullyusedbyanxiety
suffererstomanagetheseintensemanifestationsthatplaguethem.Thedevelopmentofthese
skillsisacommonthemethatiscontinuouslyfoundinmanycognitivebehavioralprogramsthat
targetanxiety.Forinstance,theFriendsforLifeandCopingCatprogramsenforcesuch
constructivemechanisms,whichoftenincludedevelopmentofpositiveselftalkwithinits
participants(Lowry-Webster, Barrett, & Dadds, 2001;Podell,Mychailyszyn,Edmunds,etal.,
2010).However,thegeneralpremisesoftheCoolKidsprogramalsoholisticallyfocusonthe
developmentofbeneficialprocesses(McLoone, et al, 2006).Theseskillsoftentakeontwo
forms,suchasemotionfocusedcopingstrategies,whicharepassivestrategiesthatachieve
emotionalstability,expression,relaxation,etc.Yet,problemfocusedcopingskillsarealsoused
todirectlyconfrontgeneralstressorsoranxieties(Myers & Thompson, 2000; Rijavec & Brdar,
1997). Additionally, de Matos, Tome,Borges,Mansano,Ferreira,&Ferreira (2008) exemplified
that through working with students either individually or in group settings, school counselors can
promote emotion management, self-esteem and self-efficacy in students with anxiety within the
use and development of coping skills.
All of these program components evidence the importance of coping skills within this
population and demonstrate the need for their exhibition in those who suffer from anxiety issues.
It appears that the development of positive coping skills can take on preventative and

SCHOOL-BASED ANXIETY INTERVENTIONS

22

intervention efforts for these populations as these skills can both mediate current anxiety
symptoms and prevent the occurrence of forthcoming manifestations when continuously
practiced by anxiety sufferers. Therefore, it seems that counseling techniques that enforce this
type of training may provide participants with an effective means to oppose the serious anxiety
issues that they face.
Furthermore, it seems that psychoeducation is also a very operative intervention that is
used in counseling students with anxiety. Both the Coping Cat and Cool Kids programs
effectively utilize psychoeducation techniques. Through these procedures, students are subjected
to information about their symptoms and are subsequently enabled to learn how to understand
and control these personal deficits (McLoone, et al., 2006; Podell,Mychailyszyn,Edmunds,et
al.,2010).Thecontinualuseofthistypeofinterventionevidenceshowefficaciousthese
techniquescanbeinalleviatingthecurrentmanifestationsofanxietysymptomsandalso
preventingfutureonsets.Therefore,psychoeducationtechniquesseemtoprovideadistinctsense
ofeffectivenessinanxietygroups,whichprovidecounselorswithamodelofhowtoeffectively
servethesepopulations.
Exposureinterventionsandgeneraloutsideworkalsohaveproventoworktogethertobe
highlyeffectiveinterventionsforstudentswithanxiety.Forinstance,theCopingCatprogram
allowsparticipantstopartakeininvivoexposureexperiencesthataremeanttoprovokeanxiety
symptomsandsubsequentcopingopportunities.Throughthis,participantscanpracticetheir
newlydevelopedskillsetsinsettingsbeyondcounseling(Beidas,Benjamin,Puleo,etal.,2010).
However,theCoolKidsandFriendsforLifeprogramsfurtherencourageparentstofacilitatethe
skillsthatstudentsarelearningincounselingoutsideofthissetting.Thisexpeditesthepractice
andmaintenanceofnewlylearnedskillsthatiscomparabletotheotherexposuretechniques

SCHOOL-BASED ANXIETY INTERVENTIONS

23

mentionedabove(Lowry-Webster, Barrett, & Dadds, 2001; McLoone, et al, 2006; Misfud &
Rapee, 2005).
Likewise,homeworktechniquesareregularlyemployedbysolutionfocusedcounselors,
whichallowparticipantstopracticetheirnewlylearnedsolutionorientedabilitiesintheir
everydaylives(Franklin,etal,2001;Kim & Franklin, 2015).Therefore,itseemsthatstudents
beingprescribedtheabilitytopracticetheskillsthatarelearnedthroughcounselingwhile
outsideofthissetting,isahighlyefficaciousinterventionthatspecificallyaidscurrentanxiety
issuesacrossmanyprogramsandtheoreticalorientations.Thispresentsschoolcounselorswith
aneffectivetechnicalmodelofhowtoaidthispopulationofstudents,whichcangreatlybenefit
thefacilitationofcounselinggroups.
Parentalinvolvementhasalsoproventobehighlybeneficialwithinthesepopulations.
BoththeFriendsforLifeandCoolKidsprograms(TheCaliforniaEvidenceBased
ClearinghouseforChildWelfare,n.d.b;LowryWebster,Barrett&Dadds,2001)utilizethese
formsofinterventionsinordertoallowparentstomonitortheanxietysymptomsofparticipants,
whilealsoenablingthepracticeofrecentlylearnedskills.Itseemsthatprescribingstudentsand
parentswiththistypeofoutsideworkwouldgreatlyarbitratethecurrentanxietysymptomsthat
studentsface,andalsosignificantlyintervenewiththeonsetofitscurrentmanifestations.These
provenratesofeffectivenessposesignificantinterventionmodelsthatschoolcounselorscan
followinregardtothispopulation.
Moreover,theprogramsdescribedabovealsoevidencetheefficacyofboostersession.
Aspostventiontechniques,boostersessionstakeplaceaftertheconclusionoftheprogramand
enforceitslongtermeffectiveness.Thistechniquewasalsoeffectivelyemployedwithinthe

SCHOOL-BASED ANXIETY INTERVENTIONS

24

FriendsforLifeandCoolKidsprograms(TheCaliforniaEvidenceBasedClearinghousefor
ChildWelfare,n.d.b; Lowry-Webster, Barrett & Dadds, 2001). Through these curriculums,
which are meant to enhance resilience to anxiety and increase peer support, booster sessions take
place after a certain amount of time following the cessation of the intervention to allow
counselors to check on the progress of participants. Therefore, these form of postvention
techniques seem to have highly efficacious places within group counseling programs and present
models of how to effectively work with these groups.
Finally,solutionfocusedcounselingtechniqueshaveproventocreatehighlyeffective
resultsforgeneralpopulationsofstudents(Brasher,2009;Fearrington,McCallum&Skinner,
2011;Franklin,etal.,2001;VallaireThomas,Hick&Growe,2011).Basedontheirextremely
efficacioussuccessrates,theseapproachestocounselingmayposefurthervaluetostudentswho
sufferfromanxietysymptoms.Therefore,theuseofitstechniques,suchasthemiraclequestion,
scaling,etc.,seemtobeaneffectivecounselingmodelforcounselorstofollowwhenfacilitating
anxietygroups,andalsopresentoperativeinterventionsinhelpingstudentstoovercomeanxiety.
Itseemsthattheseformsofinterventionsgeneratesoundframeworksofcounselingforschool
counselorstofollowwhenaidingthesepopulations.
Inordertoreapthebenefitsposedbybothofthesetheoreticalorientationsandallofthe
previouslynotedempiricalprograms,itappearsthatagroupcounselingtechniquecouldbe
formedthatwouldcombinetheseeffectivecomponents,whichhavebeenproventobeso
imperativeineachoftheseformats.This form of delivery would provide students who stuffer
from anxiety with a cognitive-behavioral viewpoint to advantageously view and improve these
issues from. However, this type of program would also entail solution-oriented approaches,
enabling student group members to view their anxiety in the context of imminent solutions and

SCHOOL-BASED ANXIETY INTERVENTIONS

25

provide positive notions of recovery. If facilitated within a group counseling context, participants
would also experience the effective characteristics that are common within this form of delivery,
which would in turn further strengthen this general approach.

Developmental Concerns
In focusing on elementary-aged students, the above set of research provides several
developmental concerns for the described population. It is seminal for young children to receive
some form of responsive services for anxiety issues at a young age because experiencing these
manifestations early in life can provide several developmental, psychological and environmental
concerns for children both currently and in the future (Bittner, Egger, Erknali, Costello, Foley &
Angold, 2007; DeSocio & Hootman, 2004; Miller, et al, 2010). Therefore, the described
intervention will focus specifically on elementary students, as it seems that this population may
have several personal and emotional issues at stake when suffering from the manifestations of
anxiety.
Furthermore, the aforementioned research base provides additional developmental
concerns for practicing professional school counselors. This is because the previously described
programs have been developed to specifically aid populations of elementary students For
instance, the Coping Cat Program targets children within the age range of 7-13, while the Cool
Kids Program is meant to aid students between 7-17 years of age (The California EvidenceBased Clearinghouse for Child Welfare, n.d.a; The California Evidence-Based Clearinghouse for
Child Welfare, n.d.b; Kendall, 1994; McLoone, et al, 2006). However, the efficacy of the Friends
for Life guidance program has also been proven effective for students in grades 4-7 (Lowry

SCHOOL-BASED ANXIETY INTERVENTIONS

26

Webster,Barrett&Dadds,2001;Rose,etal,2009).Allofthesestudiestosomedegreeincluded
elementaryparticipants,whoweresuccessfullysupportedbytheirparticipation,yetalso
includedmoreadvanceddevelopmentallevels.
Toanextent,theseratesseemtoevidencehoweffectiveanxietyprogramshaveprovento
bewithinschoolsettingsforelementaryagegroups.Nevertheless,thewiderangingempirically
studiedpopulationsseemtoalsoskewviewsoftheresultsoftheseprograms.Meaning,itseems
thatwhenfacilitatingthevariouscomponentsoftheseinterventionstoelementarystudents,their
efficacyinspecificK5populationslackdefinitiveclarity.Therefore,providingsuchgroups
specificallytoelementarystudentsmaylackasolidsenseofevidencebasedclarityofpractice,
butalsoprovideanewfoundresearchbaseforschoolcounselors.Thissubsequentlymayleadto
thenovelremediationofanxiouselementarystudentpopulations.
The Role of the School Counselor
Itseemsthatinworkingwiththestudentswithanxiety,schoolcounselorsprovideunique
perspectivesofthisissuethatmaybemoreversatilethantheservicesthatothermentalhealth
professionalscanoffer.Theirexclusiveskillsetandinterpersonalrelationshipswithstudents
providesthemwithverydistinctviewpointsthatmaybetterfacilitatestudentstoovercomethe
psychologicalissuesthatplaguethem.Forinstance,Miller, et al. (2010) cited the following:
Schoolcounselorsmaybebetterpreparedtooffersocialemotionalcurriculabecauseof
theirtraininginpsychoeducationalprogramming,theirabilitytoestimateethical
concerns,andtheircomfortwithemotionaltopics.Finally,havingtheinterventionin
schoolprovidesaccesstopeersupport;talkingaboutanxietywhileexperiencingmutual

SCHOOL-BASED ANXIETY INTERVENTIONS

27

supportfromtheirfriendsmayprovidechildrenwithasenseofacceptance,asenseof
belonging,andadecreasedsenseofisolationastheirfearsarenormalized(p.433).
As school counseling settings offer all of these beneficial characteristics, these individuals are
possibly one of the most appropriate professionals to serve students with mental health
conditions, which include anxiety. Meaning, the significance of school counselors in working
with students with anxiety conditions seems to lie within their innate predisposition to do so.
Hanie & Stanard (2009) further exemplified the responsibilities of school counselors in
helping students with these issues. These include the recognition of early manifestations,
providing initial interventions, and acting as a liaison between parents and other professionals.
However, school counselors have also demonstrated a distinct role in aiding these populations to
develop positive coping skills for their condition (McLoone, et al, 2006; Podell, Mychailyszyn,
Edmunds, et al., 2010). Based on their significant place in the lives of their students and in
school settings, counselors have constant access to students and can provide them with
fundamental help in alleviating these symptoms. This provides counselors with an exceptional
perspective of this group and with these issues in general.
RecognitionofEarlyManifestations
Asstatedabovethemajorityofanxietysymptomsoftenpersistduringanindividuals
schoolagedyears(Muris, Merckelbach, Mayer & Prins, 2000).Thesesymptomscanalso
stronglymanifestinschoolsettingsandcangreatlydetereducationexperiences(DeSocio&
Hootman,2004).Furthermore,studentswhosufferfrommoderateanxietysymptomsmaymask
thisconditionthroughexcessivetenacityanddiligence,whichcangreatlybecomeevidentat
school(Wagner,2005,ascitedinHanie&Stanard,2009).Meaning,asanxietycanoftentake
suchprevalenceinschoolsettings,itappearsthatschoolcounselorscaneasilydetectits

SCHOOL-BASED ANXIETY INTERVENTIONS

28

occurrenceandsubsequentlyfacilitateappropriateinterventions.
Untreatedanxietyconditionscanalsobedisplayedthroughverysevereanddamaging
schoolrelatedbehaviors.Forinstance,tardinessandtruancy,whicharecommonmarkersof
severeanxiety,canyieldacademicfailure,incompleteworkorevenstudentretention.Moreover,
dropoutratesandotherhighriskbehaviorshavealsoproventobecorrelatedwithanxiety
disorders(Wagner,2005,ascitedinHanie&Stanard,2009).Therefore,asanxietycanoften
causesuchsevereandincomprehensibleeffects,itisnecessaryforthoseclosetostudentstotake
apredominantroleinrecognizingtheearlymanifestationsandsymptomsoftheseissues.Inthis
way,theearlyrecognitiondonebyschoolcounselorstakesonanimportantresponsibilitythat
hasanintegralroleofallowingthesestudentstobegintounderstandandmanagetheircondition.
InitialInterventions
Alongwithrecognizingtheearlysignsofanxiety,schoolcounselorsareoften
responsibleforworkingwithstudentsattheinitialstageoftheirrecovery.Indoingthis,school
counselorscreateanatmosphereofsupportforthesestudentsinordertoeasetheirsymptoms
upondiscoveringthattheysufferfromanxietyissues(Hanie&Standard,2009).Thisdutyoften
comestofruitionasschoolcounselorsutilizepsychoeducationtechniquesintheearlystagesof
theirworkwiththesestudents(Miller,etal.,2010;TheCaliforniaEvidenceBased
ClearinghouseforChildWelfare,n.d.a;TheCaliforniaEvidenceBasedClearinghouseforChild
Welfare,n.d.b).Therefore,itseemsthattheinitialworkingtosupportstudentsisaprimary
responsibilitythatschoolcounselorscarrywhenworkingwiththispopulation,asboththe
conditionandremediationofthesestudentsproceed.
CommunicationwithParents,TeachersandOtherProfessionals

SCHOOL-BASED ANXIETY INTERVENTIONS

29

Manyschoolbasedanxietyinterventionsdemonstratetheimportanceofcommunicating
withtheparentsandteachersofstudents(TheCaliforniaEvidenceBasedClearinghousefor
ChildWelfare,n.d.b;LowryWebster,Barrett&Dadds,2001;Rose,etal,2009).School
counselorsoftentakeonthisapseudoliaisonroleandopenlycommunicatewithallofthe
stakeholdersthatsurroundthesestudents.Forinstance,consultationwithparentscaninform
thoseclosetostudentsofhowtheirchildrenarelearningtocorrecttheiranxietiesandhowthey
canpracticethesenewskillsineverydaycontexts,suchasthehome(Hanie & Stanard, 2009).
Moreover, through conferring with teachers, counselors can give educators the sensitivity
training that is necessary to manage these students in the classroom or general school settings
(Hanie&Stanard,2009;Rose, et al., 2009). Through this empirical support, it is clear that
consulting with parents and other professionals is an important role for counselors to uphold,
which contributes to the distinctive responsibilities that these professionals take on in regard to
this population.
AssistintheDevelopmentofCopingSkills
Assessingandencouragingthecopingskillsthatarenecessaryforanxiousstudent
populationstodevelopisanotherintegralresponsibilitythatschoolcounselorsoftentakeon.
Theseabilitiesareoftentaughtbyschoolcounselorsindividually,orparticularlyinsmallgroup
counseling(Hanie & Stanard, 2009).Thisrolehasproventobehighlyimportant,aspositive
copingskillsarestronglycorrelatedwithimprovedpsychologicalconditionsandgeneralstates
ofwellbeing(deMatos,etal,2008). As a result of this success in improving anxiety symptoms,
these duties seem to be central to the interventions that aid such students, giving them a unique
place in the roles held by school counselors.
Programmatic Implications

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30

The aforementioned programs and orientations provide school counselors with

frameworks of how to facilitate groups counseling interventions that remediate the anxiety
symptoms of students in both cognitive-behavioral and solution-focused approaches. As stated
previously, because all appear to be relatively successful interventions and frameworks of
counseling (Franklin, et al, 2001; Kendall, 1994; Lowry-Webster, Barrett, & Dadds, 2001;
Misfud & Rapee, 2005), it seems that certain segments could be combined in order to form a
group counseling program that uniquely and advantageously serves these populations. However,
these models also provide counselors with several programmatic implications for the
development and facilitation of such interventions.
Informational Program Development: Horizontal & Vertical Articulation
In regard to a horizontal articulation of delivery, the majority of the described program
will take place within small group formats, with students being admitted to the group after the
recommendation of parents, administrators, or faculty members, and subsequently giving their
personal consent. Students who are brought to the counselors attention will then be screened for
anxiety symptoms through the use of school-counseling oriented anxiety assessments. These
include the Beck Anxiety Inventory for Youth (BYI), the Multidimensional Anxiety Scale for
Children (MASC) or the Self-Report for Childhood Anxiety Related Emotional Disorders
(SCARED) (Thompson, Robertson, Curtis & Frick, 2013). However, if symptoms persist in
certain students following the culmination of the group, students will continue to meet with the
counselor individually, and also be referred to outside services following collaboration with
parents, as per the directions of the American School Counselor Association (2014). This will
ensure that all of the needs of students will be met, even outside of the initiation program.

SCHOOL-BASED ANXIETY INTERVENTIONS

31

In terms of vertical articulation, group meetings will consist of intervention responsive

services that target the current anxiety symptoms of participants. However, prevention services
will also be facilitated, in order to thwart the occurrence of forthcoming anxiety symptoms.
Therefore, in terms of the RTI Tiered System, it appears that this program would satisfy a Tier
Two categorization, which meets the unique needs of a select group of students with advanced
intensity and focus (Ockerman, Mason & Hollenbeck, 2012). Smith, Kinard & Lozo (2008) went
on to write that Tier Two interventions often take place within small group environments for a
select group of students in order to build certain skill sets, which specifically aid these
individuals (as cited in Ockerman, Mason & Hollenbeck, 2012). This is because the
aforementioned group program will target a select few students within a group counseling
environment and also aim to build certain skills within group members that can arbitrate the
onset of anxiety symptoms.
In looking at these interventions from a comprehensive perspective of grades K-12, it
seems that though these programs specifically target elementary students, the skills learned in
these groups can greatly aid each participant as they progress through subsequent grade levels.
As Bittner, Egger, Erknali, Costello, Foley and Angold (2007) describe, the onset of anxiety
issues can plague sufferers throughout the lifespan, meaning learning to eradicate and prevent
these symptoms early on may lead to more successful and beneficial experiences at higher grade
levels. Therefore, though this program distinctly targets elementary populations, its effects
holistically aid students within a full K-12 perspective. In doing this, this form of intervention
will satisfy several of the American School Counselors (2004) student competencies, such as

PS: B1.4 Develop effective coping skills for dealing with problems
PS:C1.11 Learn coping skills for managing life events
PS:A1.1 Develop positive attitudes toward self as a unique and worthy person
PS:A1.5 Identify and express feelings.

SCHOOL-BASED ANXIETY INTERVENTIONS

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By satisfying all of these components, it appears that such an intervention will be vertically
articulated in order to satisfy the extensive needs of student populations.
Significant Areas of Delivery System
Delivery systems are highly integral segments of the ASCA National Model and
comprehensive school counseling programs. The American School Counselor Association (2012)
documented that this component accounts for the manner in which certain interventions are
facilitated, in order to better the personal, academic and career development of students. These
programs can be delivered through direct methods, in which students are helped within
immediate interactions with school counselors. The program noted above exclusively features
counseling groups, which have proven to be highly effective by a strong research base (Beidas,
Benjamin, Puleo, et al., 2010; Podell, Mychailyszyn, et al., 2010; McLoone, et al., 2006). It
seems that while facilitating forms of this intervention, counselors can serve students directly and
contribute to their holistic development in doing so. Therefore, as these programs so heavily
focus on group counseling processes, the bulk of this intervention would rely on direct
responsive services.
Though school counselors can provide a plethora of direct services to students who suffer
from anxiety, the American School Counselor Association (2014) goes on to affirm that these
services should be brief and goal-oriented. Meaning, school counselors do not perform longstanding counseling for mental health issues and should refer students to other professionals
when cases prove to be highly severe. As anxiety issues do fall under the scope of mental illness,
counselors must keep their work with such groups brief and refer to outside services if the
symptoms of students persist. These required referral sources render to indirect services by
school counselors, which sharply contrast with the involved direct services (American School

SCHOOL-BASED ANXIETY INTERVENTIONS

33

Counselor Association, 2012), and evidence the importance of both forms of delivery when
aiding these populations.
Many other components of the aforementioned intervention also comprise various
indirect service types. For instance, the American School Counselor Association (2012) cited that
consultation is an indirect service that occurs when school counselors share methods that support
student achievement with parents and other educators. The described program would aim to
encourage the importance of working with the parents of group participants, in order to support
the development of student group members (McLoone, et al., 2006; Misfud & Rapee, 2005).
This would in turn enable more indirect services to students to take place within it.
Themes of the ASCA National Model
The themes of American School Counselor Associations (2012) National Model include
leadership, advocacy, systematic change and collaboration. As implied by the research noted
above, it seems that all of these themes are comprised in a school counselors role in working
with student with anxiety. For instance, a school counselors professional leadership is advanced
through their delivery of comprehensive counseling program in an extremely effective manner,
which promotes the academic and personal development of students (American School
Counselor Association, 2012). The above literature evidences the effectiveness of certain anxiety
programs (Kendall, 1994; Lowry-Webster, Barrett, & Dadds, 2001; Misfud & Rapee, 2005), and
provides counselors with a model of how to carry out this effectiveness within their own
interventions. Therefore, it seems that the multitude of empirical literature related to the topic
affords counselors with the ability to deliver their programs in a highly operational manner, and
consequently advance their roles as professional leaders.

SCHOOL-BASED ANXIETY INTERVENTIONS

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School counselors also thematically become advocates who help their students to develop
high academic, professional and socioemotional standards (American School Counselor
Association, 2012). As anxiety seems to be so profoundly interrelated with ones academic and
emotional life (DeSocio & Hootman, 2004; Miller, et al., 2010), by working with students to
overcome these symptoms, counselors can support the holistic well being of their students within
these measures. In essence, by working to alleviate student anxiety, counselors can also become
strong advocates, which thematically fits the requirements of the ASCA National Model.
The collaboration theme of the model calls for counselors to work with educators, parents
and other professionals outside of the school system to more fully support their students
(American School Counselor Association, 2012). In the context of anxiety interventions,
counselors often work alongside parents and teachers to allow their students to practice the skills
that they learn while in counseling on their own, and also through referring to outside mental
health services if need be (American School Counselor Association, 2014; Hanie&Stanard,
2009;Kendall,1994;Misfud & Rapee, 2005; Rose, et al., 2009). Therefore, as collaboration is
so strongly present in a school counselors responsibility to students with anxiety, their work
with this population soundly accords with this component of the ASCA National Model.
Finally, thematic systematic change enables counselors to work to satisfy the fundamental
needs of the students with whom they work, while also acting as an example of advantageous
transformation in their respective school networks. In doing this, counselors identify the existing
needs within their student populations and then seek to reverse these trends (American School
Counselor Association, 2012). In working to better the personal and academic deficits that are
facilitated by manifestations of anxiety (DeSocio & Hootman, 2004; Miller, et al., 2010),
counselors can remediate this symptomatology and subsequently repeal its negative

SCHOOL-BASED ANXIETY INTERVENTIONS

35

manifestations within general student demographics. It seems that by facilitating these minute
changes, counselors can influence the entire networks of their students and school system on a
large scale, which in essence endorses notions of systematic change.
Role of the School Counselor in Delivery, Management and Accountability
In the delivery systems of counseling programs, the American School Counselor
Association (2012) writes that direct and indirect delivery methods are important components of
this area of the National Model. As stated previously, school counselors take on integral direct
and direct roles when carrying out these interventions, leaving its primary facilitation
responsibility on these professionals. Therefore, when carrying out such an intervention with
student groups, it seems that their functions in facilitating these groups and collaborating with
other stakeholders specifically drives these programs, and is therefore essential to its entire
delivery.
The American School Counselor Association (2012) also noted that to serve the
developmental needs of students, counseling programs must be successfully and proficiently
managed. In carrying out the aforementioned intervention, this component can be facilitated
through utilizing empirical assessments that reveal the needs of student populations, including
closing-the-gap action plans. Counselors can also assess the achievement, engagement and
behavioral data of student group members in order to assess how anxiety may be manifesting and
affecting within their lives (American School Counselor Association, 2012). By conducting these
measurements, school counselors can assess how prevalent this issue is within their study body
and also understand how group participants are affected by it.
Moreover, the accountability component holds counselors with great responsibility
toward the effectiveness of their programs and its influence on student development (American

SCHOOL-BASED ANXIETY INTERVENTIONS

36

School Counselor Association, 2012). To assess the results of such a program in the lives of
students, counselors can utilize anxiety assessments, such as the Beck Anxiety Inventory for
Youth (BYI), the Multidimensional Anxiety Scale for Children (MASC) or the Self-Report for
Childhood Anxiety Related Emotional Disorders (SCARED) (Thompson, Robertson, Curtis &
Frick, 2013) before and after its implementation to evaluate the noticeable discrepancies in the
anxiety levels of participants. Moreover, counselors can also utilize the achievement,
engagement and referral data of students, as well as the observations of faculty, parents and
administrators, in order to determine how a programs results holistically affect the lives of
students. Finally, it seems that through evaluating a students personal response to an
intervention after it culmination, through means of a semi-structured interview, the counselor
will be enabled to cognize its effectiveness directly from its participants. All of these measures
would provide the counselor with a well-rounded view of the groups efficacy, providing them
with advanced notions of accountability.
Conclusion
Many authors have surveyed the prevalence of anxiety issues within populations of
young children (Allison, et al, 2014). Furthermore, a large body of empirical research focuses on
interventions that work to reverse this emotional issue(Kendall,1994;Lowry-Webster, Barrett,
& Dadds, 2001; McLoone, et al., 2006; Misfud & Rapee, 2005). This empiricism demonstrates
the importance that school counselors have in working with these populations. However, the
efficacy of both the solution-focused and cognitive-behavioral theoretical orientations seem to
also have the capacity of reducing the anxiety of student populations (Henderson & Thompson,
2011). It seems that the value all of these frameworks of theoretical orientations and empirically
based interventions have the ability to form a highly advantageous group intervention when

SCHOOL-BASED ANXIETY INTERVENTIONS

37

successful techniques from each model are utilized. In this way, the above set of research
provides a sound foundation for associated school counseling interventions that are directed
toward the anxiety symptoms of the sensitive population of elementary students.

SCHOOL-BASED ANXIETY INTERVENTIONS

38

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American School Counselor Association (2012). The ASCA national model: A framework for

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American School Counselor Association. (2014). The professional school counselor and group
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