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Title: An Evaluation of the FRIENDS program : A Therapeutic Intervention for Anxious Young People
Author: Sykes, Michelle
ISNI:       0000 0004 2674 7460
Awarding Body: University of Exeter
Current Institution: University of Exeter
Date of Award: 2009
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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.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available