Testing the Functional Profiles of School Refusal Behavior and Clarifying Their Relationship With School Anxiety

Virtual Reality Exposure Therapy for Reducing School Anxiety in Adolescents: Pilot Study

BACKGROUND

Virtual reality exposure therapy (VRET) is a promising treatment approach for anxiety disorders. However, while its efficacy has been demonstrated in adults, research on the efficacy of VRET in the treatment of adolescents with anxiety disorders is largely lacking.

OBJECTIVE

A pilot study was carried out to test whether exposure to a virtual reality (VR) school environment elicits state anxiety and autonomic arousal in adolescents with school anxiety (diagnoses covering social anxiety disorder or specific phobia involving school contexts). In addition, we examined whether repeated VR exposure led to a reduction in this fear response, trait school anxiety, and social anxiety symptoms. Moreover, the relationship of presence, the subjective sense of "being there," during VR exposure with anxiety measures and treatment response was examined.

METHODS

In a pilot study, 10 adolescents with school anxiety (age range 14 to 17 years) participated in five VRET sessions. Self-reported state anxiety, heart rate, and presence during exposure, as well as trait school anxiety and social anxiety before and after treatment, were measured.

RESULTS

The VR scenario induced state anxiety and autonomic arousal. After VRET, a significant reduction in state anxiety (η2=0.74) and social anxiety symptoms (d=0.82) as well as a trend toward a decrease in trait school anxiety were observed, while autonomic arousal did not change. In addition, presence during VR exposure was associated with state anxiety and treatment response.

CONCLUSIONS

Our findings indicate the feasibility and potential effectiveness of VRET as a treatment method for symptoms of school and social anxiety in adolescents.

School anxiety profiles in Spanish adolescents and their differences in psychopathological symptoms

School anxiety and psychopathological symptoms tend to co-occur across development and persist in adulthood. The present study aimed to determine school anxiety profiles based on Lang’s model of the triple response system (cognitive anxiety, psychophysiological anxiety, and behavioral anxiety) and to identify possible differences between these profiles in psychopathological symptoms (depression, hostility, interpersonal sensitivity, somatization, anxiety, psychoticism, obsessive-compulsive, phobic anxiety, and paranoid ideation). The School Anxiety Inventory (SAI) and the Symptom Assessment-45 Questionnaire (SA-45) were administered to 1525 Spanish students (49% girls) between 15 and 18 years old (M = 16.36, SD = 1.04). Latent Profile Analysis identified four school anxiety profiles: Low School Anxiety, Average School Anxiety, High School Anxiety, and Excessive School Anxiety. A multivariate analysis of variance revealed statistically significant differences among the school anxiety profiles in all the psychopathological symptoms examined. Specifically, adolescents with Excessive School Anxiety showed significantly higher levels of the nine psychopathological symptoms than their peers with Average School Anxiety and Low School Anxiety. In addition, the Excessive School Anxiety profile scored significantly higher in phobic anxiety than the High School Anxiety group. These findings allow to conclude that it is necessary enhance well-being and reduce psychopathology of those adolescents who manifest high and very high reactivity in cognitive, psychophysiological, and behavioral anxiety.

School Refusal Behavior Profiles, Optimism/Pessimism, and Personality Traits in Spanish Children

The relationship between school refusal behavior (SRB) profiles and personality traits has received little attention from investigators. Identifying the profiles of students with school attendance problems may improve the understanding of the characteristics defining these students. The aim of this study was to identify different SRB profiles and analyze the relationship between these profiles, and optimism/pessimism and personality traits. The School Refusal Assessment Scale-Revised, the Youth Life Orientation Test, and the Big Five Questionnaire were administrated to 739 Spanish students aged 8–11 (Mage = 9.92; SD = 1.12). Pearson’s correlation coefficients revealed a significant association between personality dimensions and SRB. Three distinct profiles were identified: (1) SRB by negative reinforcement (high scores on avoiding school-related stimuli provoking negative affectivity), (2) SRB by positive reinforcement (high scores on pursuing positive tangible reinforcement outside of school), and (3) Low SRB. The SRB profile by positive reinforcement scored higher on Extraversion, Agreeableness, Conscientiousness, Openness, and Optimism, whereas the SRB profile by negative reinforcement scored higher on Neuroticism and Pessimism. More statically significant differences were found between the negative and positive reinforcement profiles. The role of negative personality traits and pessimism as risk factors for students who are truant or refuse to attend school are discussed.

Exploring different types of school refusers through latent profile analysis and school-related stress associations

Children experience significant number of stressful situations at school during their academic years. The aims of this study were to identify school refusers groups of children through latent profile analysis and to test their associations with school-related sources and manifestation of stress. Data were obtained from 755 schoolchildren (8-11 years) from public and private schools of Alicante and Murcia (Spain), using the School Refusal Assessment Scale-Revised (SRAS-R) and the School Situation Survey (SSS). In general, positive and statistically significant correlations were identified between school refusal behavior and school-related sources and manifestations of stress. School refusers groups were derived from the combination of high and low scores in the four functional conditions assessed by the SRAS-R. "Low School Refusal Behavior Profile,""School Refusal Behavior by Positive Reinforcement Profile" and "Mixed School Refusal Behavior Profile" were identified. The percentages of children within these profiles were 47.7%, 46.6%, and 5.7%, respectively. The Mixed School Refusal Behavior Profile was the group with the highest average scores in the school-related stress factors. In contrast, the group with the lowest mean scores was the Low School Refusal Behavior Profile. By comparing the Low School Refusal Behavior Profile with the Mixed School Refusal Behavior Profile, the largest effect sizes were found. Findings are discussed from a socio-ecological perspective considering the school context conditions as key elements in the development of school refusal behaviors.