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An evaluation of the FRIENDS programme:

A cognitive behaviour therapy intervention to promote emotional resilience

P. Stallard,
N. Simpson,
T. Carter,
C. Osborn,
S. Bush
University of Bath

Published in 'Archives of Disease in Childhood', 90, 1016-1019, 2005

The aim of this study was to evaluate the FRIENDS programme, an intervention strategy designed to enhance children's emotional resilience using cognitive behaviour therapy (CBT).  The programme consists of 10 sessions of CBT that teach children how to use practical skills to identify their anxious feelings using behavioural, physiological, and cognitive methods.  Children also learn how to relax, how to face and overcome their problems, and how to identify thoughts that increase their anxiety levels and to replace them with more helpful ones.


The participants were recruited from areas with the highest rates of social and economic disadvantages within Bath and northeast Somerset.  197 children, aged 9-10 years, completed two standardised measures of emotional health before and after completing the FRIENDS programme.  One questionnaire assessed various types of anxiety, such as social phobia, separation anxiety, panic attacks and agoraphobia, physical injury fears, obsessive compulsive disorder, and generalised anxiety disorder.  The other questionnaire measured general self-esteem, as well as social, academic, and parental self-esteem. 

After completing FRIENDS, children displayed significantly reduced levels of anxiety and increased levels of self-esteem.  The 10% of children with the highest anxiety and lowest self-esteem scores were identified as 'high risk' and 60% of these children experienced positive changes by the end of the programme.  However, several children within this category had higher scores for anxiety at the end of the programme but none of them had lower self-esteem.  190 children provided a qualitative evaluation of FRIENDS and the majority considered it to be fun and would recommend it to a friend.  Around two thirds believed that the programme had helped them and that they had learned new skills.  In fact, 40% had used their new skills to help someone else.  

However, only 43% thought they had been given enough time to complete the written assignments and workbooks and some children found this part of the programme particularly challenging.  As a result, the researchers have made some crucial changes in the way the programme is structured in order to reduce the workload required of each child.  Another slightly negative finding was that only 51% of the children felt safe talking about themselves.  Many children had experienced significantly traumatic events, such as domestic violence, parental drug and alcohol abuse, and bullying.  Some parents had also died during the course of the programme therefore the circumstances where children felt unsafe discussing their problems were understandably difficult for them.  On a more positive note, 81% did feel that their concerns had been properly heard and understood by the psychologists conducting the study.

In conclusion, the authors emphasised the benefits of using preventative programmes like FRIENDS.  Crucially, they are less stigmatising and they encourage the whole class to develop a positive culture within the classroom while supporting the continued use of newly acquired skills.

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