An Open Trial of Intensive Cognitive-Behavioral Therapy for School Refusal

Abstract

Cognitive-behavioral therapy (CBT) has been used to address the myriad of problems within cases presenting with school refusal. Although CBT for school refusal shows promise in increasing attendance, results to date have been mixed. Treatment studies on CBT for school refusal differ in regards to the dosage of CBT (i.e. session time and frequency) provided. The current study examined the use of intensive CBT, in which sessions lasting 1.5–2 hours were delivered on a daily basis. Altogether, 25 participants were enrolled in an intensive CBT school refusal program. Based upon their needs, individual treatment interventions were designed that incorporated standard CBT procedures, as well as interventions specific to the needs of a student/family. Treatment was delivered on a daily basis over 3 weeks. At pretreatment, all students were spending less than 90% of time in their assigned school/classes, with 88% not attending any school. At posttreatment, 60% of students were attending school at greater than 90% attendance. Intensive CBT for school refusal shows promise in increasing time spent in school. It allows clinicians the necessary time to address maintaining factors of school refusal within a short timeframe (daily). In addition, it allows extended time in session to build skills and also address any daily issues that arise. Further study is needed to directly compare intensive CBT to CBT on a weekly basis and to examine the student characteristics associated with response to treatment.