Is Cognitive-Behavioral Therapy Effective in Reducing Internalizing Symptoms in the Context of a Rural School Mental Health Program?

School mental health (SMH) programs provide an opportunity to serve adolescents who might otherwise not receive adequate mental health care. The effectiveness of the Assessment, Support, and Counseling (ASC) Center, a SMH program in rural western North Carolina, in treating adolescent internalizing symptoms was evaluated in this study. Participants were 36 students between 14 and18 years old. They were predominately Caucasian (94%) and female (69%). After approximately 16 sessions of CBT, 60% of the sample was recovered or improved overall based on the Reliable Change Index (RCI) guidelines. The results indicated that 42% of those who began treatment with elevated depression symptoms and 28% of those who began treatment with elevated anxiety symptoms were functioning within the normal range of functioning at post-treatment. The majority of the sample demonstrated an improvement or stability in grade point average, attendance, and discipline referrals from baseline to final and follow-up semesters. Results are consistent with large randomized controlled trials for internalizing disorders, including child and adolescent anxiety, and suggest that a moderate dosage of CBT in the context of a rural school mental health program was associated with a reduction of psychological distress and stability in academic variables among the majority of participants.