Title:
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An Evaluation of the FRIENDS program : A Therapeutic Intervention for Anxious Young People
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The rise in mental health issues in children and adolescents in the U.K has increased the
need for evidence based therapeutic interventions. The focus of the research in this thesis
was to contribute towards the growing evidence base for effective cognitive-behavioural
therapy (CBT) interventions suitable for young people which could be delivered in school
settings. This research specifically aimed to evaluate a manual based intervention to address
anxiety in young people. The 'FRIENDS for Youth' (Barrett 1998) program was chosen for its
existing success in Australia and its strong roots in CBTtheory.
The underlying theory behind CBT links back to Bandura's (1986) Social Cognitive
Theory. This theory outlines that human behaviour is determined by the reciprocal
interaction of three factors; cognitive, behaviour and the environment. Social Cognitive
Theory places a strong emphasis on cognition and suggests that an understanding of the
cognitive process involved can lead to behaviour being predicted, understood and changed.
Bandura (1986) postulated that individuals hold a self-system that provides them with a
degree of control over their own thoughts, feelings and actions. Bandura theorised that it
was this self-system that contained the cognitive and affective structures and allowed for
individuals to learn through observation, plan alternative strategies, regulate and change
behaviour and engage in self reflection. Based on this theory, CBT follows the idea that
understanding, recognising and restructuring individual cognitions can lead to changing
behaviours.
Bandura (1986) also felt self reflection was an important component in behaviour change as
it led people to evaluate their experiences and alter their own thought processes. These self evaluations include perceptions of self efficacy Le. a person's beliefs about personal
competence. Beliefs of efficacy verify the level of effort a person will make in a difficult
situation, how long they will persist in overcoming barriers and their level of resilience in
facing adverse situations. Greater levels of self efficacy predict greater levels of effort,
persistence and resilience. Social cognitive theory also suggeststhat perceived self efficacy plays a
central role in anxiety arousal. In threatening situations, perceived coping inefficacy results in high
levels of anxiety and distress with anxiety arousal and avoidant behaviour being co-effects of the
perceived inefficacy (Bandura, 1989). Even more interesting and indeed of relevance to the research
being proposed is Bandura's (1989) notion that efficacy beliefs also influence individual's thoughts
processes and emotional reactions. Low levels of self efficacy suggest there is a belief that things are
tougher than they actually are which in turn fosters feelings of stress, anxiety and depression which
in turn narrows the ability to problem solve. The most effective way to develop self efficacy is to
create a strong sense of efficacy through mastery of experiences which are structured to build
coping skills and instil beliefs that one can have some control over the situation. Smith, Arkoff &
Wright (1989) reported that perceived efficacy predicted improvements in performance and
reduced anxiety in his sample of highly anxious students. Bandura, Adams & Beyer (1977) suggested
that the impact of therapy upon behaviour change is mediated by the extent to which the individuals
acquire the belief they can perform the behaviours to which the therapy is orientated.
With that in mind, the focus of this research is to assess the effects, experience and
effectiveness ofthe FRIENDS program when used as a targeted therapeutic intervention in a
secondary school for a small group of self selected young people with anxiety. Paper 1
focuses on the summative evaluation, looking at the outcome effects the FRIENDS program
has on participant's levels of anxiety, self efficacy and well being whilst Paper 2 focuses on the more formative evaluation. This paper looks at the young people's lived experience of
the intervention and the meanings and value they placed upon the experience. Together,
the results of the research from these two papers allows for an overall evaluation of the
FRIENDS program to be made which builds upon the earlier work of Barrett (1998) and the
existing success of the FRIENDS program as demonstrated in the Australian literature. The
findings of this research not only extend the evidence base towards the impact FRIENDShas
on its users but also considers the social validity of the program through examining the
users' perceptions of the program. Furthermore, the findings contribute towards discussion
regarding the impact the program has and the value of the intervention as a therapeutic
intervention which could be used in secondary schools in the U.K.
The results of this study found significant reductions in anxiety levels using pre- and postcomparisons.
Greatest differences were found for social anxiety, generalised anxiety and
oeD. Lasting changes to anxiety levels were maintained at follow up. An increase in social
self efficacy was also found although these changes were not found to be significant. No
significant changes were found for well being.
Significant themes found from the qualitative analysis show that the young people placed
value upon the friendships they formed during the intervention, the positive changes they
saw in themselves which they attributed to the FRIENDSprogram and the usefulness of the
new skills they developed as part of the program. The results of the focus group suggested a
high social validity of the FRIENDS program from the participant's direct experience.
Together, these findings provide evidence of a wider impact of success that was measured
by the outcomes alone in paper 1.The research outlined in this thesis discusses the findings of the two phase evaluation and
gives consideration to future direction and areas for further research. Lastly, questions are
raised about the role of the educational psychologist and the delivery of therapeutic
interventions.
This research will be of benefit to educational psychologists and other professionals working
with children and young people as a way of raising their awareness of mental health in
young people and strengthening the evidence base for FRIENDSas a therapeutic program to
be used in practice. Although this research was very small scaled, the findings have made a
start at outlining some of the benefits for the use of the FRIENDS program in schools to
reduce anxiety. These findings could also be used to contribute towards the development of
policy and practice regarding the way anxiety is managed within schools and the
accessibility of therapeutic type interventions available to school settings.
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