Cognitive Behaviour Therapy (CBT) is an effective psychological intervention for children and young people with anxiety disorders (James et al, 2013). This has led to interest in whether CBT programmes can be widely provided in schools to prevent or ameliorate anxiety symptoms in children.

Results from school based anxiety prevention trials are encouraging (Neil & Christensen 2009; Fisak, Richard, Mann 2011). Before the widespread use of school based preventive programmes can be advocated methodologically robust evaluations are required to demonstrate that they are effective when transported to everyday settings.

To undertake a pragmatic randomised controlled trial (RCT) of a universal school based CBT programme (Friends for Life) for children aged 9-10 years of age .

Three arm RCT comparing Friends for Life delivered by trained health or school leaders with usual school provision (Stallard et al,2012). Primary outcome the Revised Child Anxiety and Depression Scale (RCADS) at 12 month follow-up.

A total of 1362 children from 40 schools participated with 1257 (92%) being re-assessed at follow-up. There was a difference in adjusted mean child report RCADS scores for health-led versus school-led FRIENDS (−3.94, 95%CI −6.41 to −1.47) and health-led FRIENDS versus usual school provision (2.66, 95%CI −5.22 to −0.09). Health-led CBT resulted in greater reductions in symptoms of anxiety than the other two arms (Stallard et al 2014),

Our pragmatic trial demonstrates that universally delivered anxiety prevention programmes can be effective when transported into schools. However, effectiveness varies depending upon who delivers them.