Japan: Cognitive behavioral therapy sessions at school


Anxiety disorders are very common psychological disorders among children. Anxiety negatively affects the sense of self-worth, leading to poor academic achievement. Additionally, anxiety can exacerbate low self-esteem in children who already suffer from it. This increases the likelihood that they avoid socializing, engage in negative interactions with peers, and miss out on classes. If left untreated, anxiety can lead to serious psychological disorders over time. To remedy this situation, a preventive intervention for children, based on cognitive-behavioral therapy, called the ” Journey of the brave ” was developed and introduced in Japanese schools as early as 2014.


Cognitive-behavioral therapy is specifically indicated to address psychopathological disorders, such as anxiety, panic attacks and phobias. It combines the cognitive component with the behavioral one, as the therapist provides the tools to manage anxious behavior and change negative and erroneous beliefs and perceptions of the mind .

While the program proved somewhat effective, each session took 45 minutes to complete over 10 weeks, during which time normal class time was lost. In Japan, school-going children have busy schedules due to a very busy school schedule, and it is quite difficult to set aside time for a prevention program.

Recently, a group of researchers led by Dr. Yuko Urao, a professor at the Research Center for Child Mental Development, Drs. Eiji Shimizu and Michiko Yoshida of Chiba University Graduate School of Medicine, and Dr. Yasunori Sato of Keio University School of Medicine, has developed a simplified and shorter version of the Journey of the Brave CBT program . Their findings have been published in Volume 22 of BMC Psychiatry.


“The effectiveness of the ‘Journey of the Brave’ cognitive-behavioral therapy anxiety prevention program for Japanese elementary school children has been confirmed by previous studies. But its large-scale implementation and deployment has been problematic due to the difficulty of ensuring a large class duration, ten 45-minute sessions,” said Dr Urao of the rationale behind the study.


The team modified the method by increasing the weeks and decreasing the duration of the sessions: 14 weeks for a duration of only 20 minutes per session. They also changed the time of the sessions: during class activity time in the morning, instead of after school hours, for 10-11 year olds. This age group was chosen because children experience classroom reshuffling during these years and tend to take on new responsibilities as school or class leaders.

Furthermore, the children were divided into control and intervention groups, with the former not participating in the therapy sessions. The team evaluated the children pre-intervention and post-intervention, as well as during a 2-month follow-up period. Anxiety symptoms were measured with the Spence Children’s Anxiety Scale (SCAS), while behavior problems were measured with the Strengths and Difficulties Questionnaire (SDQ). The results showed a statistically significant reduction in SCAS scores during the 2-month follow-up period, as well as a reduction in SDQ scores. These results suggest that the children benefited from the cognitive-behavior therapy ( CBT ) program.) when it was administered in a short, divided format.


“Because this version of the program is shorter, more schools will be able to implement it. Also, the more schools that participate, the more teachers will be able to focus on children’s anxiety. This will lead to an improvement in the school environment where children will maintain their peace of mind”. Dr. Urao said while discussing the findings. Why is it important to prevent anxiety symptoms in school-aged children? Dr. Urao thinks: “When CBT-based anxiety prevention programs prevail and help children learn self-control over their anxious feelings, their mental health problems will diminish, allowing them to grow to their full potential.


  • School-based cognitive behavioral intervention program for addressing anxiety in 10- to 11-year-olds using short classroom activities in Japan: a quasi-experimental study (


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