explanation Cognitive behavioural treatment (cbt) is found to be effective with anxious school refusers. Still, about one-third to onehalf of the school-refusing youths show little or no response to cbt, indicating that there is room for improvement. Efforts to improve cbt warrant investigations of working mechanisms of change.
aim To examine whether changes in adolescent self-efficacy are associated with changes in school attendance and internalising problems following cbt for school refusal in adolescence.
method The sample consisted of 19 adolescents who participated in the evaluation of the ‘@school project’, a developmentally-sensitive cbt for school refusal in adolescence. The cbt treatment was designed as a developmentally appropriate, modularised manual-based treatment comprising cognitive and behavioral interventions. The measures related to treatment outcomes (anxiety, depression, school fear, parentreported internalising behaviour) and the mediator variable (self-efficacy) were assessed at pretreatment, post-treatment, and follow-up. Innovative statistical approaches were implemented to test for working mechanisms of change in uncontrolled small samples.
results Increases in self-efficacy were accompanied by increases in school attendance and decreases in internalising behavior at posttreatment and follow-up. With regard to the mechanisms of change, increases in self-efficacy were associated with increases in school attendance and decreases in school fear at post-treatment. At two-month follow-up, increases in selfefficacy were not associated with increases in school attendance or decreases in internalising problems
conclusion There is evidence for adolescent self-efficacy being a working mechanism of cbt for school refusal. Reduction in fear of school and increase in school attendance depended, to some extent, upon enhanced belief in adolescents’ ability to engage in school-attending behaviors. This hints at the importance of targeting self-efficacy during treatment. There was no support found for self-efficacy being a working mechanism of cbt at follow-up, suggesting that some other mechanisms of change may be operating two-months following cbt.