***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Adolescent anxiety is debilitating , the most frequently diagnosed adolescent mental health problem , and leads to substantial long-term problems . A r and omized controlled trial ( n = 138 ) was conducted to test the effectiveness of a  biofeedback video game ( Dojo ) for adolescents with elevated levels of anxiety . Adolescents ( 11–15 years old ) were r and omly assigned to play Dojo or a control game ( Rayman 2 : The Great Escape ) . Initial screening for anxiety was done on 1,347 adolescents in five high schools ; only adolescents who scored above the “ at-risk ” cut-off on the Spence Children Anxiety Survey were eligible . Adolescents ’ anxiety levels were assessed at pre-test , post-test , and at three month follow-up to examine the extent to which playing Dojo decreased adolescents ’ anxiety . The present study revealed equal improvements in anxiety symptoms in both conditions at follow-up and no differences between Dojo and the closely matched control game condition . Latent growth curve models did reveal a steeper decrease of personalized anxiety symptoms ( not of total anxiety symptoms ) in the Dojo condition compared to the control condition . Moderation analyses did not show any differences in outcomes between boys and girls nor did age differentiate outcomes . The present results are of importance for prevention science , as this was the first full-scale r and omized controlled trial testing indicated prevention effects of a video game aim ed at reducing anxiety . Future research should carefully consider the choice of control condition and outcome measurements , address the potentially high impact of participants ’ expectations , and take critical design issues into consideration , such as individual- versus group-based intervention and contamination issues Background Depression often emerges for the first time during adolescence . There is accumulating evidence that universal depression prevention programs may have the capacity to reduce the impact of depression when delivered in the school environment . Objective This trial investigated the effectiveness of SPARX-R , a gamified online cognitive behavior therapy intervention for the prevention of depression relative to an attention-matched control intervention delivered to students prior to facing a significant stressor — final secondary school exams . It was hypothesized that delivering a prevention intervention in advance of a stressor would reduce depressive symptoms relative to the control group . Methods A cluster r and omized controlled trial was conducted in 10 government schools in Sydney , Australia . Participants were 540 final year secondary students ( mean 16.7 [ SD 0.51 ] years ) , and clusters at the school level were r and omly allocated to SPARX-R or the control intervention . Interventions were delivered weekly in 7 modules , each taking approximately 20 to 30 minutes to complete . The primary outcome was symptoms of depression as measured by the Major Depression Inventory . Intention-to-treat analyses were performed . Results Compared to controls , participants in the SPARX-R condition ( n=242 ) showed significantly reduced depression symptoms relative to the control ( n=298 ) at post-intervention ( Cohen d=0.29 ) and 6 months post-baseline ( d=0.21 ) but not at 18 months post-baseline ( d=0.33 ) . Conclusions This is the first trial to demonstrate a preventive effect on depressive symptoms prior to a significant and universal stressor in adolescents . It demonstrates that an online intervention delivered in advance of a stressful experience can reduce the impact of such an event on the potential development or exacerbation of depression . Trial Registration Australian New Zeal and Clinical Trials Registry ACTRN12614000316606 ; https://www.anzctr.org.au/Trial/ Registration /Trial Review .aspx?id=365986 ( Archived by WebCite at http://www.webcitation.org/ 6u7ou1aI9 BACKGROUND Children with anxious or depressive symptoms are at risk of developing internalizing disorders and their attendant morbidity . To prevent these outcomes , school-based cognitive-behavioral therapy ( CBT ) has been developed , but few studies include active control conditions . We evaluated a preventive CBT program targeting internalizing symptoms relative to an activity contrast condition post-intervention and at 1-year follow-up . METHODS One thous and one hundred and thirty-nine children from Grade s 3 - 6 from a diverse sample of schools , were screened with the Multidimensional Anxiety Scale for Children and Children 's Depression Inventory . Those with t>60 on either measure were offered participation in a r and omized 12-week trial , school-based group CBT versus a structured after-school activity group of equal duration . We explored several therapeutic elements as potential predictors of change . RESULTS One hundred and forty-eight children participated ( 84 boys , 64 girls ; 78 CBT , 70 contrast ; 57 % Caucasian ) and 145 completed the program . Self-reported anxious and depressive symptoms decreased significantly over time ( η(2)=.15 and .133 , respectively ) , with no group by time interaction . There was a trend toward fewer children meeting diagnostic criteria for an anxiety disorder on the Anxiety Disorders Interview Schedule at 1-year post-CBT than post-contrast ( 6/76 versus 12/69 ) . Positive reinforcement of child behavior was associated with change in anxiety symptoms ; checking homework was understood with change in depressive symptoms . CONCLUSIONS Findings suggest that children with internalizing symptoms may benefit from both school-based CBT and structured activity programs . Replication , longer follow-up , and further studies of therapeutic elements in child CBT are indicated . IS RCT N Registry identifier : IS RCT N88858028 , url : Although few prevention studies have been design ed to investigate the course of prevention effects over time , it seems that the effects on depressive symptoms increase from post-intervention to 6-month follow-up but then decrease with longer lags to follow-up . Furthermore , previous prevention studies have found differential intervention effects for boys and girls without testing possible explanations for this effect . The present r and omized control group study with 301 8th- grade students examined the effects of a depression prevention program from baseline until 12-month follow-up . As expected , while positive intervention effects were found on girls ' depressive symptoms , no such effects were found on boys ' depressive symptoms . Further , the positive intervention effects on girls ' depressive symptoms increased to the 6-month follow-up and remained stable through the 12-month follow-up , while depression symptoms in control-group girls increased from 6-month to 12-month follow-up . Further exploratory analyses revealed that neither baseline conduct problems nor cognitive or social knowledge of the prevention program at 12-month follow-up alone explained the sex effect . However , some limited evidence was found indicating that total knowledge ( cognitive and social ) might partially explain the effect but there was significant variability remaining to be explained BACKGROUND Anxiety in children is common , impairs everyday functioning , and increases the risk of severe mental health disorders in adulthood . We investigated the effect of a classroom-based cognitive behaviour therapy prevention programme ( FRIENDS ) on  anxiety symptoms in children . METHODS Preventing Anxiety in Children though Education in Schools ( PACES ) is a three-group parallel cluster r and omised controlled trial . Interventions were given between September , 2011 , and July , 2012 , with schools as the unit of allocation and individual participants as the unit of analysis . We enrolled state-funded junior schools in southwest Engl and . We sent information to all eligible schools ( state-funded junior schools in southwest Engl and ) inviting them to enrol in the study . School year groups were assigned by computer-generated r and omisation ( 1:1:1 ) to receive either school-led FRIENDS ( led by teacher or school staff member ) , health-led FRIENDS ( led by two trained health facilitators ) , or usual school provision . Children were not masked to treatment allocation . The allocated programme was given to all students ( aged 9 - 10 years ) in the school year ( ie , universal delivery ) as part of the school curriculum as nine , 60 min weekly sessions . Outcomes were collected by self-completed question naire administered by research ers masked to allocation . Primary outcome was symptoms of anxiety and low mood at 12 months assessed by the Revised Child Anxiety and Depression Scale ( RCADS 30 ) . Analyses were intention to treat and accounted for the clustered nature of the design . The study is registered , number IS RCT N23563048 . FINDINGS 45 schools were enrolled : 14 ( n=497 children ) were r and omly assigned to school-led FRIENDS , 14 ( n=509 ) to health-led FRIENDS , and 12 ( n=442 ) to usual school provision . 1257 ( 92 % ) children completed 12 month assessment s ( 449 in health-led FRIENDS , 436 in school-led FRIENDS , and 372 in usual school provision ) . We recorded a difference at 12 months in adjusted mean child-reported RCADS scores for health-led versus school-led FRIENDS ( 19·49 [ SD 14·81 ] vs 22·86 [ 15·24 ] ; adjusted difference -3·91 , 95 % CI -6·48 to -1·35 ; p=0·0004 ) and health-led FRIENDS versus usual school provision ( 19·49 [ 14·81 ] vs 22·48 [ 15·74 ] ; -2·66 , -5·22 to -0·09 ; p=0·043 ) . We noted no differences in parent or teacher ratings . Training teachers to deliver mental health programmes was not as effective as delivery by health professionals . INTERPRETATION Universally delivered anxiety prevention programmes can be effective when used in schools . However , programme effectiveness varies depending on who delivers them . FUNDING National Institute for Health Research Public Health Research Programme PURPOSE Although cognitive-behavioral interventions have been successful in treating depression , no studies were found that focused solely on reducing negative thinking via group intervention as a means of preventing depression in at-risk groups . The purpose of this r and omized controlled trial was to test the effectiveness of a cognitive-behavioral group intervention in reducing depressive symptoms , decreasing negative thinking , and enhancing self-esteem in young women at risk for depression . DESIGN A r and omized controlled trial with 92 college women ages 18 to 24 who were at risk for depression was conducted . METHOD Participants were r and omly assigned to either the control or experimental group . The experimental group participated in a 6-week cognitive-behavioral group intervention . Data on self-esteem , depressive symptoms , and negative thinking were collected via self-report question naires from control and experimental groups at baseline , 1 month after the intervention , and at 6-month follow-up . Data were analyzed using mixed-model methodology and the Cochran-Mantel-Haenszel chi-square test . FINDINGS Compared to those in the control group , women who received the intervention had a greater decrease in depressive symptoms and negative thinking and a greater increase in self-esteem , and these beneficial effects were maintained over 6-months . CONCLUSIONS The findings document the effectiveness of this cognitive-behavioral group intervention and indicate empirical support for the beneficial effects of reducing negative thinking by the use of affirmations and thought-stopping techniques on women 's mental health Youth in underserved , urban communities are at risk for a range of negative outcomes related to stress , including social-emotional difficulties , behavior problems , and poor academic performance .  Mindfulness-based approaches may improve adjustment among chronically stressed and disadvantaged youth by enhancing self-regulatory capacities . This paper reports findings from a pilot r and omized controlled trial assessing the feasibility , acceptability , and preliminary outcomes of a school-based mindfulness and yoga intervention .  Four urban public schools were r and omized to an  intervention or wait-list control condition ( n = 97 fourth and fifth grade rs , 60.8 % female ) . It was hypothesized that the 12-week intervention would reduce involuntary stress responses and improve mental health outcomes and social adjustment . Stress responses , depressive symptoms , and peer relations were assessed at baseline and post-intervention . Findings suggest the intervention was attractive to students , teachers , and school administrators and that it had a positive impact on problematic responses to stress including rumination , intrusive thoughts , and emotional arousal A large proportion of children experience sub clinical levels of anxiety and cognitive-behavioral therapy ( CBT ) aim ed at preventing anxiety disorders is moderately effective . However , most at-risk children do not seek help or drop out of programs prematurely because of stigma , lack of motivation , and accessibility barriers . Applied games have received increased attention as viable alternatives and have shown promising results , but direct comparisons between applied games and the gold-st and ard CBT are lacking . Our aim was to investigate whether the applied game MindLight is as effective as CBT ( i.e. , Coping Cat ) within an indicated prevention context . We conducted a r and omized controlled non-inferiority trial with a sample of 174 children ( 7- to 12-year olds ) with elevated levels of anxiety  , comparing MindLight to CBT .  Anxiety was assessed with self- and parent-reports at pre- and post-program , and at 3- and 6-month follow-ups . Intention-to-treat and completers-only confidence interval approach and latent growth curve modeling showed an overall significant quadratic decrease in child- and parent-reported anxiety symptoms over time and , as predicted , the magnitude of improvement was the same for MindLight and CBT . The within-group effect sizes were small to medium at post-test ( − 0.32 to − 0.63 ) , and medium to large ( − 0.60 to − 1.07 ) at 
    Output:
    
There was a lack of evidence to support any one type of intervention being effective to prevent depression in universal or targeted primary or secondary setting s. Comparison-adjusted funnel plots suggest the presence of small- study effects for the universal secondary anxiety analysis .
INTERPRETATION Considering unclear risk of bias and probable small study effects for anxiety , we conclude there is little evidence that educational setting -based interventions focused solely on the prevention of depression or anxiety are effective .