A school-setting pilot study of the e-learning version of the "Journey of the Brave": a universal anxiety-prevention program based on cognitive behavioral therapy.

Background: School-based cognitive behavioral therapy (CBT) programs delivered by teachers are effective in preventing anxiety among children. Internet-based CBT has emerged as an efficient method for delivering such interventions. Our previous research demonstrated the feasibility of the e-learning version of Journey of the Brave in reducing anxiety among Japanese elementary school students in a home-based learning environment. This study aimed to evaluate the feasibility and acceptability of the e-learning version in school settings and to identify any practical implementation issues.

Methods: We conducted a single-arm study with 204 elementary school students aged 10-12 years. Participants completed the e-learning program during regular classroom hours. Of these, 180 students who completed more than 80% of the program and agreed to participate in the study were included in the analysis. We evaluated changes in anxiety symptoms using the Spence Children's Anxiety Scale (SCAS), alongside learning logs and a post-program satisfaction questionnaire.

Results: The estimated mean SCAS score, analyzed using a generalized linear mixed model, showed a significant decrease of 2.6 points from pre-intervention to follow-up (p = .04, 95% CI [-5.08, -0.09]). Subgroup analysis revealed a 6.4-point reduction in boys compared to a 0.5-point decrease in girls. In School A, the SCAS score slightly increased by 0.4 points, while in School B, it decreased by 3.1 points. Significant interaction effects were observed between time and gender (p = .03) and between time and school (p = .04). The mean comprehension test score (true/false) was 13.2 out of 16 (SD = 2.2).

Conclusion: The Journey of the Brave e-learning version was feasible and well-accepted in school settings. Student self-reports suggested that they may have applied the CBT knowledge and skills in their daily lives. Future studies should explore the contextual factors influencing program effectiveness and determine optimal conditions for its implementation.

Trial Registration:  UMIN, UMIN000057115, Registered February 21, 2025.