Objective: We examined the effectiveness of targeted school-based cognitive-behavioral therapy (CBT) for adolescents (12L16 years of age) with anxiety, and tested whether brief CBT was noninferior to standard duration CBT. Method: A randomized controlled study of 313 adolescents (mean 14.0 years, SD ¼ 0.84, 84% girls) were recruited through school health services to 10 weeks CBT group interventions. Groups of 5 to 8 adolescents were randomly allocated to brief (5 sessions, comprising 5.5 hours) or standard CBT (10 sessions, comprising 15 hours), or 10 weeks waitlist (WL). Self-reported and parent-reported youth anxiety symptoms, impairment from anxiety, depressive symptoms,and clinical severity were assessed pre-and postintervention, after WL, and at 1-year follow-up. Results: Targeted school based CBT significantly reduced adolescents' anxiety symptoms with small to moderate effect sizes compared to WL (Cohen d ¼ 0.34 for youth report and d ¼ 0.53 for parent report). According to the parents, also adolescents' impairment from anxiety was significantly reduced compared to WL (d ¼ 0.51). Pre to post changes in anxiety symptoms were small to moderate (within-group effect sizes between d ¼ 0.41 and d ¼ 0.67). Although no significant differences in effects were found between brief and standard CBT, brief CBT was not noninferior to standard CBT. Outcomes from both interventions were sustained at 1-year follow-up. Conclusion:Targeted school-based CBT interventions reduced anxiety, impairment, and depressive symptoms in adolescents. Both brief and standard CBT demonstrated efficacy, but brief CBT was not noninferior to standard CBT. By administering school-based CBT to youths with anxiety symptoms, we may reach young people with effective interventions at an earlier phase in their lives. Clinical trial registration information: School Based Low-intensity Cognitive Behavioral Intervention for Anxious Youth (LIST); http:// clinicalrials.gov/; NCT02279251.

BackgroundIt has been discussed whether the relationship between a patient on sick leave and his/her general practitioner (GP) is too close, as this may hinder the GP’s objective evaluation of need for sick leave. Independent medical evaluation involves an independent physician consulting the patient. This could lead to new perspectives on sick leave and how to follow-up the patient.Methods/designThe current study is a randomized controlled trial in a Norwegian primary care context, involving an effect evaluation, a cost/benefit analysis, and a qualitative evaluation. Independent medical evaluation will be compared to treatment as usual, i.e., the physicians’ and social insurance agencies’ current management of long-term sick-listed patients. Individuals aged 18–65 years, sick listed by their GP and on full or partial sick leave for the past 6 months in Hordaland county will be included. Exclusion criteria are pregnancy, cancer, dementia or an ICD-10 diagnosis. A total sample of 3800 will be randomly assigned to either independent medical evaluation or treatment as usual. Official register data will be used to measure the primary outcome; change in sickness benefits at 7, 9 and 12 months. Sick listed in other counties will serve as a second control group, if appropriate under the “common trend” assumption.DiscussionThe Norwegian effect evaluation of independent medical evaluation after 6 months sick leave is a large randomized controlled trial, and the first of its kind, to evaluate this type of intervention as a means of getting people back to work after long-term sickness absence.Trial registrationClinicalTrials.gov NCT02524392. Registered June 23, 2015.

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