A comparison of two teacher trainings on student anxiety

Abstract

The purpose of this study was to compare the impact of two teacher trainings, both focused on identifying student anxiety and implementing empirically supported anxiety reduction strategies in the classroom. A comparison of teachers’ satisfaction with their training was examined along with pre–post training changes on measures of teachers’ knowledge and use of evidence-based anxiety reduction strategies, perceived confidence in assisting students with anxiety, and teaching self-efficacy. Volunteer elementary teachers in New England USA were randomized to receive either a six-hour interactive training (Teacher Anxiety Program for Elementary Students; TAPES; n = 41) or a three-hour didactic (Teacher Anxiety Training; TAT; n = 37). Fifty-four teachers completed their respective training (mean age 40.9; SD = 10.2; 98% female; 96% White). Results from t-tests indicated that levels of training satisfaction were high and similar across trainings. Mixed-design ANOVA analyses found that teachers receiving both trainings showed significant improvements in teacher knowledge and use of anxiety reduction strategies, confidence, and self-efficacy. Teachers receiving TAPES, compared to TAT, showed greater improvements in their knowledge of anxiety reduction strategies. Findings highlight the need and perceived value of training teachers on topics related to identifying and managing student anxiety.

Keywords

teacher training professional development student anxiety elementary school teachers anxiety reduction

Introduction

Excessive anxiety is among the most common form of pediatric psychopathology in the United States of America (USA) and globally and impairs academic functioning (Battaglia et al., 2017; Ghandour et al., 2019; Racine et al., 2021; Swan & Kendall, 2016). Students with anxiety present challenges to teachers who are tasked with managing their students’ social, emotional, behavioral, and educational impairment caused by excessive anxiety. For instance, data show that students with higher (compared to lower) levels of anxiety are more dependent on, and have more conflict with, their teachers (Zee & Roorda, 2018), and a majority of teachers report that student anxiety negatively impacts their classrooms (Birnbaum et al., 2017). While teachers are not responsible for diagnosing student anxiety, their accurate observations of student anxiety often affect their teaching methods (i.e. how they respond to students in the classroom to optimize their learning); moreover, teachers may refer a student to a school mental health professional. The mental health needs of students internationally have risen dramatically in light of the global COVID-19 pandemic, highlighting the likelihood that teachers globally will encounter excessive student anxiety (Chavira et al., 2022; World Health Organization, 2022).

In many countries, federal regulations mandate schools provide supports for students with emotional, behavioral, developmental, or learning challenges that interfere with learning. For students in the USA, a student with an anxiety disorder may have an Individualized Education Program (IEP), a 504 Plan, or specific classroom modifications (e.g. sitting next to the teacher, frequent breaks to see the nurse or counselor; additional time to complete tests; not presenting in front of the class). However, most students with excessive anxiety do not receive any supports or interventions (Merikangas et al., 2010; Olfson et al., 2015). Moreover, some evidence indicates that school-based supports present in IEP or 504 Plans for students with anxiety may actually be at odds with long-term anxiety reduction (Conroy et al., 2020; Phillips et al., 2022) These data support the need for additional training in evidenced-based anxiety reduction strategies for school-based personnel. Despite the challenges that students with anxiety present to teachers, teacher training on how to identify and reduce student anxiety is lacking (Sindelar et al., 2010). Recent data from a small sample of elementary teachers (N = 51) who took a knowledge test on student anxiety revealed that the average score was 57% correct (Ginsburg et al., 2022). Moreover, teachers themselves report a need for more training and support in this area (Maclean & Law, 2022; Moon et al., 2017). The consequences of this gap in teacher knowledge and skills related to anxiety management can be grave for both teachers and students. Teachers with minimal training in identifying and managing students’ anxiety are less likely to feel efficacious and may engage in teaching practices that maintain anxiety, such as allowing students to avoid what they are frightened of (e.g. reading a loud in class). Allowing students to avoid anxiety provoking situations, a term in the psychological literature known as accommodation of anxiety and referred to throughout this manuscript, is associated with higher student anxiety (Ginsburg et al., 2022).

Although the vast majority of teachers never receive any training in evidence-based strategies for identifying and assisting students with excessive anxiety (Reinke et al., 2011), meta-analyses indicate that, with adequate training and coaching, teachers can effectively deliver “universal” classroom-based social-emotional curricula with numerous positive effects on student outcomes (Werner-Seidler et al., 2017). To the best of our knowledge, only one teacher-led anxiety specific intervention, called FRIENDS (Anticich et al., 2013; Barrett et al., 2005; Barrett & Turner, 2001) has been evaluated (research groups in Australia, Canada, and the UK), and evidence for its effectiveness on students is mixed; moreover, no evaluation of the training's impact on teachers’ knowledge or behavior has been reported.

No study has investigated the effectiveness of anxiety specific trainings on teachers’ knowledge and skills. However, a growing literature has investigated the effects of general mental health training for teachers. Anderson et al. (2019) conducted a systematic review of the effectiveness of mental health training programs on improving teacher knowledge (e.g. of adolescent depression, anxiety and other related mental health concerns). Of the eight studies identified, all reported an improvement in mental health knowledge and attitudes toward mental health at post training using teacher report questionnaires. For instance, Kutcher et al. (2016) evaluated the mental health literacy knowledge of 38 secondary school teachers before and after a 3-day mental health literacy training course. Mental health literacy, defined as “knowledge and beliefs about mental health problems which aid their recognition, management or prevention” (Jorm et al., 1997), was assessed using a teacher completed knowledge assessment survey. Results indicated that after training, teachers’ scores on the knowledge survey increased significantly and that 84% of teachers reported that they had identified a student who had a mental health disorder or mental health problem. While this study shows teachers’ ability to learn information about mental health, it did not include a comparison training group and no follow-up was conducted regarding the accuracy of teacher identified students.

In a larger study, Long et al. (2018) examined the impact of an online mental health role-play simulation on changes in teachers’ attitudes and self-reported helping behaviors for students experiencing psychological distress. Elementary school teachers (N = 18,896) were randomly assigned to a 45–90-minute online training or a wait-list control. In the intervention condition, the role-play simulation taught motivational interviewing (MI) skills with a virtual student and parent experiencing psychological distress. The Gatekeeper Behavior Scale, which assessed attitudinal dimensions (i.e. preparedness, likelihood to implement and self-efficacy in implementing interventions with students and parents) was administered at baseline and post training (three months later). Results demonstrated that post-training scores in the intervention group were significantly higher than the wait list control group on all attitudinal dimensions measures. Similar to Kutcher et al. (2016) and other studies, findings demonstrate that with training, teachers are able to retain new knowledge of skills related to mental health. However, although studies report an improvement in teacher knowledge and attitudes, little evidence suggests that programs improve teachers’ behavior in regard to helping students’ mental health. Further, none of these studies have examined the impact of an anxiety-specific training on elementary school teachers’ knowledge and behavior.

To further contribute to the literature on teacher training on mental health, we developed two teacher trainings as part of a larger study to examine the effects of a teacher-led home-school intervention for student anxiety (Ginsburg et al., 2019). Both trainings focused on the assessment of student anxiety and evidence-based intervention strategies for reducing anxiety that could be applied to students and in the classroom. The current study compared teachers’ satisfaction with these two trainings (described below) as well as the pre-post impact (i.e. after 10 weeks) of these trainings on teachers’ knowledge of student anxiety, use of evidence-based anxiety reduction strategies (including reductions in their own accommodation of anxiety), perceived confidence in assisting students with anxiety and teaching self-efficacy. The first training, referred to as the Teacher Anxiety Program for Elementary Students (TAPES) was a six-hour interactive training. The second training was referred to as the Teacher Anxiety Training (TAT) and was a three-hour didactic training that was developed to serve as a comparison condition that mimicked typical teacher professional development seminars. Considering the literature showing that interactive trainings (e.g. those using role plays and corrective feedback) enhance learning (Fixsen et al., 2005; Sholomskas et al., 2005), we hypothesized that while teachers in both trainings would demonstrate an increase in knowledge, skills (including reductions in anxiety accommodation), confidence, and self-efficacy; those teachers who received the TAPES training would show greater gains relative to those who received TAT.

Methods

Participants

Fifty-four public elementary school teachers in New England USA were randomized and trained in TAPES (n = 28) or TAT (n = 26). Demographic and professional characteristics of the 54 teachers and comparisons by group (TAPES vs. TAT) are presented in Table 1. Teachers instructed kindergarten (n = 9), first (n = 9), second (n = 1), third (n = 15), fourth (n = 8), and fifth (n = 6) grades, and six were special education teachers.

Table 1.

Teacher demographics and professional characteristics (n = 54) n (%) or mean (SD).

Characteristic	Total	TAPES	TAT	Statistical test^a p-value
N	54	28 (51.9%)	26 (48.2%)
Females	53/54 (98.2%)	27/28 (96.4%)	26/26 (100%)	> .999
Age	40.9 (10.2)	42.6 (9.5)	39.0 (10.8)	.193
Ethnicity (Hispanic/Latino)	2/54 (3.7%)	2/28 (7.1%)	0/26 (0%)	.493
Race (White)	52/54 (96.3%)	26/28 (92.9%)	26/26 (100%)	> .999
(Black)	1/54 (1.9%)	1/28 (3.6%)	0/30 (0%)
(Other)	1/54 (1.9%)	1/28 (3.6%)	0/30 (0%)
Highest earned degree (Bachelor’s)	3/54 (5.6%)	0/28 (0%)	3/26 (11.5%)	.105
(Masters)	51/54 (94.4%)	28/28 (100%)	23/26 (88.5%)	.105
Total number of teaching experience years	13.1 (7.9)	14.3 (7.2)	11.8 (8.5)	.254

TAPES: Teacher Anxiety Program for Elementary Students; TAT: Teacher Anxiety Training.

Either χ² or Fisher's exact test for categorical variables and two-sample t-test for continuous variables; all statistical tests were two-sided.

Description of trainings

TAPES: The TAPES training consisted of a six-hour interactive workshop. The content of the training included (1) didactics on psychoeducation about pediatric anxiety disorders, (2) a discussion about common manifestations of anxiety in the classroom, and (3) an overview of Cognitive Behavioral Therapy (CBT)-based anxiety-reduction strategies that could be applied to students and in the classroom. In addition, the TAPES training reviewed manuals and handouts to facilitate the delivery of the CBT anxiety reduction strategies in the context of five school-home meetings. Teachers watched videos of mock meetings conducted by the study team and engaged in role-plays of the meetings with in vivo corrective feedback. The training was delivered by study staff. A detailed description of each of the five meetings can be found in Ginsburg et al. (2019).

TAT: The TAT training consisted of a three-hour didactic training on student anxiety. The content of the training included (1) psychoeducation about pediatric anxiety disorders, (2) a discussion about common manifestations of anxiety in the classroom, and (3) an overview of CBT-based anxiety-reduction strategies that could be applied to students and in the classroom. The TAT training was designed to replicate a typical professional development day (e.g. didactic style).

The entirety of the TAT training and the first 3 h of the TAPES training presented teachers with identical didactic information. However, teachers in the TAPES training also received training in how to apply the information to individual students in the context of five conjoint parent–student–teacher meetings using role-playing and receiving direct feedback from trainers.

Procedures

This study was approved by the host university's Institutional Review Board and each school's principal. Teachers were recruited using a variety of strategies including flyers distributed to teachers directly, from school principals or school district administrators announcing the opportunity for teachers to participate in a research study that included free training on how to assist students with anxiety. All interested teachers were contacted to obtain informed consent. After teachers completed informed consent, they were randomized to TAPES or TAT (1:1 stratified by grade). Before beginning the training (baseline), teachers completed the baseline knowledge assessment and other measures listed below. Approximately 8–10 weeks after the training (post), teachers completed the same measures, as well as a measure assessing their satisfaction with the training. In addition, after training, teachers were asked to identify a student with anxiety with whom to apply their training skills and to complete a measure of anxiety accommodation (i.e. the Teacher Accommodation Scale of Anxiety or TASA; described below). Thirty-nine teachers identified at least one student and completed the TASA pre and post-enrollment of the student (i.e. 8–10 weeks later). Teachers were compensated with a $50 gift card for attending the training.

Measures

Training Satisfaction. Teachers in both TAPES and TAT completed a Training Satisfaction Questionnaire that was adapted from training satisfaction questionnaires used in previous studies (e.g. Ginsburg et al., 2021). Specifically, teachers provided ratings reflecting their satisfaction with the training on seven common aspects (e.g. To what degree do you think the training will help you manage anxiety in your students?) (see Table 2). Each item was rated on a 7-point Likert scale ranging from 1 (not at all satisfied) to 7 (very much satisfied). An eighth item asked teachers to rate their confidence in implementing the anxiety reduction strategies for their students using a 7-point Likert scale ranging from 1 (not at all confident) to 7 (extremely confident).

Table 2.

Teacher training satisfaction items (seven common items only) mean (SD).

Training satisfaction items	TAPES (n = 21)	TAT (n = 20)	Statistical test^a p-value
Overall, how satisfied were you with the training day?	6.4 (0.7)	6.5 (1.1)	.805
Did the training meet the stated objectives?	6.5 (0.9)	6.5 (1.1)	.935
To what degree do you think the training will help you manage anxiety in your students?	6.1 (0.9)	6.2 (1.1)	.982
To what degree do you think the skills and information from training will benefit anxious students?	6.3 (0.7)	6.4 (1.1)	.953
Are the anxiety reduction skills consistent with current teacher practices?	6.2 (0.7)	6.0 (0.9)	.355
Based on this training, how feasible do you think it will be to implement these skills with students?	6.1 (0.9)	6.5 (0.8)	.178
Do you feel that you gained valuable knowledge from the training?	6.6 (0.5)	6.2 (1.4)	.224

TAPES: Teacher Anxiety Program for Elementary Students; TAT: Teacher Anxiety Training.

Item Scale: 1 = not at all; 4 = moderately/sometimes; 7 = very much.

Two-sample two-sided t-test.

Teacher Knowledge of Anxiety Reduction Strategies (Piselli et al., 2022). The teacher knowledge assessment was modified from previous studies (Ginsburg et al., 2008) and consisted of 25 (pre-version) – 24 (post-version) open-ended short-answer (e.g. You notice that Marcus (a student in your class) appears tense and flushed prior to beginning a test. List two strategies you might use to reduce Marcus’ anxiety) and multiple-choice questions (e.g. Which of the following is NOT an example of an evidence-based anxiety reduction strategy?) measuring teachers’ knowledge of anxiety symptoms and anxiety-reduction strategies based on cognitive behavioral principles. The short answer questions assessed teachers’ ability to apply knowledge based on brief vignettes describing students with anxiety. Two similar forms were developed to measure change from the baseline (pre-training) to post-assessment. Performance on this measure is reported as a total percentage correct. The first two authors, who modified the current version, independently scored each teacher's open-ended/short answer items. Percent agreement was over 85%, and disagreements were discussed until resolved. Correct answers were based on published pediatric anxiety treatment literature. Prior versions of the knowledge assessment for school clinicians and teachers demonstrated that scores (percent correct) improved significantly pre- to post-training (Ginsburg et al., 2008; Piselli et al., 2022).

Classroom Strategies Questionnaire. The Classroom Strategies Questionnaire is a 16-item measure developed by the study team and based on established anxiety reduction literature (Chorpita, 2007; Conroy et al., 2022; Thompson, 2021). This measure assessed the presence and use of anxiety management strategies in the classroom. The questionnaire consisted of two sections. In the first section, teachers responded on a yes-no scale to six items indicating their use of specific strategies (e.g. Please indicate whether you currently have any of the following items in your classroom by selecting Yes or No (e.g. calm down corner, deep breathing poster/instructions; coping self-talk poster/instructions). The second section consisted of 10 items measuring how often teachers used specific strategies during the past month (e.g. Please indicate how often you have used the following strategies in your classroom during the PAST MONTH (e.g. deep breathing, a calm-down corner, encouraging or teaching students to use coping self-talk) on a 5-point Likert scale (never, few times per month, once per week, few times per week, daily). Total scores ranged from 0 to 6 in the first section and 0 to 40 in the second section. Higher scores indicate a greater number and higher frequency of strategies implemented. Cronbach's alpha for the six and ten items were .62 and .82, respectively.

Teacher Accommodation Scale for Anxiety (TASA). The TASA was adapted from the Family Accommodation Scale, Anxiety (FASA, Lebowitz et al., 2013) by the study team. In the current study, teachers rated nine items reflecting the degree to which they engage in anxiety-related accommodation behaviors of student anxiety. Each item assessed the frequency (using a 5-point scale ranging from Never (0) to Daily (4), yielding a Total Accommodation Score. Sample items include: “Have you modified classroom activities because of this student's anxiety?” In evaluations of the parent/caregiver version of this measure (FASA), the Total Accommodation scale had high internal consistency (alpha = .90) and was correlated significantly with anxious but not depressive symptoms, displaying evidence of convergent and divergent validity (Lebowitz et al., 2013). In the current study, Cronbach's alpha for the nine-item scale was .88, and published data indicate that teachers who report engaging in more accommodating behaviors have students with higher avoidance and anxiety (Ginsburg et al., 2023).

The Teachers’ Efficacy Beliefs Scale (Tschannen-Moran & Hoy, 2001). The Teachers’ Efficacy Beliefs Scale is a 12-item questionnaire designed to measure teachers’ perceived efficacy in engaging students, using effective instructional strategies, and in implementing classroom management systems. Teachers respond on a 9-point Likert-type scale (nothing [1], very little [3], some [5], quite a bit [7], a great deal [9]) indicating the extent to which certain statements create difficulties for themselves. The measure yields three subscale scores: (1) Student Engagement (e.g. How much can you do to motivate students who show low interest in school work?); (2) Instructional Strategies (e.g. To what extent can you provide alternative explanations or examples when students are confused?); and (3) Classroom Management (e.g. How well can you establish a classroom management system with each group of students?). Higher scores on each subscale indicate a greater degree of efficacy. The measure is correlated with other measures of teaching efficacy, demonstrating construct validity (Casanova & Azzi, 2015; Tschannen-Moran & Hoy, 2001). Internal consistencies for the subscales in the current sample were 0.86, 0.84, and 0.89, for the Student Engagement, Instructional Strategies, and Classroom Management subscales, respectively.

Clinical Global Impression – Severity (CGI-S) Scale (Guy, 1976). The CGI-S is an independent evaluator global rating of anxiety severity ranging from 1 (Not at all ill) to 7 (Extremely ill). The CGI-S has been used extensively in child anxiety treatment trials (Walkup et al., 2008).

Data analyses

Attrition analyses were performed to determine whether trained teachers who did not complete one or more post-training/intervention measures differed from those who provided completed data on baseline teacher demographic characteristics and their randomized training group assignment using Fisher's Exact and Wilcoxon Rank Sum tests. Between-group differences at baseline on demographics and teacher characteristics were examined using a two-sample t-test and Wilcoxon Rank Sum test for continuous variables and χ² or Fisher's exact test for categorical variables. Within-group pre–post changes and between groups comparisons on other measures were examined using mixed-design ANOVA that included a group-by-time interaction term. Specifically, a statistically significant interaction implied that pre–post changes differed by group. All statistical tests were two-sided at significance level of 5%. All parametric statistical tests’ assumptions had been checked and their results were compared with non-parametric tests whenever appropriate. Only results of statistical tests that met assumptions were reported. Moreover, when non-parametric tests agreed with parametric tests, only parametric tests were reported. Cohen's d effect sizes were calculated for both between- and within-group differences from test statistics and corresponding degrees of freedom using the effect size R package (Ben-Shachar et al., 2020, https://cran.r-project.org/web/packages/effectsize/index.html, https://easystats4u.shinyapps.io/statistic2effectsize/). In the traditional interpretation of Cohen's d, an effect size of 0.2 and above is considered small, 0.5 and above represents a medium effect, and 0.8 and above is considered a large effect (Cohen, 1988). However, clinically meaningful effects should be determined in relation to the scale of each instrument.

Results

Preliminary analyses and baseline group comparisons on teacher characteristics and student anxiety severity

There was no difference in the percentage of teachers randomized to TAPES (13/41 = 31%) and TAT (11/37 = 30%) who failed to complete training. There were also no differences between teachers who enrolled and did not enroll a student with respect to randomized training programs, teacher age, and years of teaching experience. There was no difference in enrolled student anxiety severity at baseline between those recruited by TAPES-trained teachers verses TAT trained teachers based on independent evaluators’ rating on the 7-point Clinical Global Impressions – Severity (CGI-S) score (mean (SD) = 4.52 (1.01) and 4.41 (0.91) for TAPES and TAT, respectively, and equal variance t(52) = 0.41, p = .685). Among the 54 teachers who completed their respective training, between 9% and 24% did not complete one or more post-training/intervention measures. Attrition analyses found no differences between teachers with complete versus incomplete data by assigned training conditions, age, and years of teaching experience. Table 1 presents teachers’ demographic and professional characteristics by group. No group differences were found.

Group Comparisons on Training Satisfaction. Table 2 presents teachers’ scores on the Training Satisfaction Questionnaire by a group. Satisfaction ratings were high, and no group differences were found.

Pre–Post Group Comparisons on Teacher Outcomes. Table 3 presents pre–post within and between-group differences. With respect to teacher knowledge, both trainings significantly improved teachers’ knowledge test scores. The TAPES training, compared with the TAT training, had a statistically significant greater effect on teacher knowledge test scores (d = 2.21 for TAPES training, 1.50 for TAT training, 0.87 for the between-group differences in pre–post-training test scores). Both trainings also led to statistically significant increases in the number of anxiety reduction strategies used (d = 0.48 for TAPES and 0.55 for TAT) and the frequency of their use (d = 0.78 for TAPES and 0.68 for TAT) based on the Classroom Strategies Questionnaire. No between groups differences over time were found on this measure. The TAPES training led to a statistically significant reduction in teachers’ accommodation of student anxiety (p < .001) based on the TASA. TASA scores of teachers in the TAT training did not significantly decrease (p = .053). Between-group differences were not statistically different; however, the between-group effect size was medium (p = .055, d = 0.74). Both training programs significantly increased teachers’ perceived confidence in their ability to implement anxiety reduction strategies (d = 0.48 for TAPES and 0.56 for TAT), though there were no between-group pre–post change differences (p = .676, d = 0.14). Similarly, both training conditions led to statistically significant increases in self-efficacy beliefs on Classroom Management (d = 0.69 for TAPES and d = 0.36 in TAT) and Student Engagement (d = 0.46 for TAPES and 0.35 for TAT) subscales. Teachers receiving the TAPES (but not TAT) training also reported significant increases on the Instructional Strategies scale (d = 0.65 for TAPES and d = 0.25 for TAT), but the between-group test did not reach statistical significance.

Table 3.

Pre- and post-training and first student comparisons for teacher outcomes mean (SD) [n].

Measure	TAPES					TAT				Between Group pre-post-differences statistical test
Measure	Pre	Post	Pre–post diff	p-value	Effect size d	Pre	Post	Pre–post diff	p-value	Effect size d	p-value	Effect size d
Teacher knowledge test % score^b	55.2 (12.2) [n = 27]	84.1 (10.2) [n = 21]	27.0 (9.1) [n = 21]	< .001	2.21	56.5 (9.9) [n = 26]	75.8 (10.4) [n = 19]	20.1 (9.6) [n = 19]	< .001	1.50	.011	0.87
Classroom strategies	[n = 27]	[n = 25]	[n = 25]			[n = 26]	[n = 22]	[n = 22]
Total use^b	3.0 (1.4)	3.7 (1.9)	0.7 (1.3)	.003	0.48	2.3 (1.0)	3.1 (1.4)	0.9 (0.8)	< .001	0.55	.627	0.15
Total frequency^b	23.7 (8.8)	30.0 (6.5) [n = 24]	7.0 (7.1) [n = 24]	< .001	0.78	20.7 (7.4)	25.6 (6.1)	7.0 (5.5)	< .001	0.68	.772	0.09
Confidence in ability to implement anxiety reduction strategies^b	4.9 (1.6) [n = 28]	5.9 (0.7) [n = 21]	0.6 (1.2) [n = 21]	.004	0.48	4.9 (1.4) [n = 26]	6.0 (0.5) [n = 20]	1.1 (1.4) [n = 20]	.001	0.56	.676	0.14
TASA total accommodation scale	[n = 19]	[n = 14]	[n = 14]			[n = 19]	[n = 17]	[n = 17]
Total accommodation^a	15.2 (6.6)	7.6 (3.7)	5.3 (4.5)	< .001	0.85	12.7 (6.3)	11.0 (7.5)	2.7 (5.1)	.053	0.38	.055	0.74
Self-efficacy	[n = 27]	[n = 26]	[n = 15]			[n = 26]	[n = 23]	[n = 23]
Classroom management^b	27.7 (3.9)	31.8 (2.9)	4.1 (3.9)	< .001	0.69	27.3 (4.8)	29.4 (3.6)	2.5 (5.0)	.020	0.36	.142	0.44
Student engagement^b	27.5 (3.6)	30.1 (4.0)	2.5 (3.4)	.003	0.46	26.5 (4.1)	28.4 (4.2)	2.2 (4.8)	.022	0.35	.646	0.14
Instructional strategies^b	28.0 (3.1)	30.9 (3.3)	3.2 (3.8)	< .001	0.65	28.8 (3.3)	30.0 (3.6)	1.2 (3.2)	.103	0.25	.070	0.55

TAPES: Teacher Anxiety Program for Elementary Students; TAT: Teacher Anxiety Training.

Within group pre–post differences: ^apre–post; ^bpost–pre; all statistical tests were two-sided.

Discussion

The current study examined the impact of two elementary teacher trainings focused on identifying student anxiety and the use of anxiety reduction skills in the classroom. Overall, results indicated that teachers were highly satisfied with both trainings, and both trainings resulted in a broad range of improvements (e.g. in the knowledge of student anxiety and frequency in using anxiety reduction strategies in the classroom, teaching self-efficacy). Teachers who received the TAPES, compared to the TAT training, evidenced greater improvements in teacher knowledge.

Training Satisfaction. Teachers in both trainings reported similarly high levels of satisfaction. Importantly, teachers felt that they gained valuable knowledge, that the trainings helped them to better manage anxiety in their students, that the skills would benefit their students, and the skills taught were feasible to implement in their classroom. This finding was encouraging as satisfaction with training is often associated with teacher behavior change (McCormick et al., 1995). Specifically, when teachers are informed about the rationale for learning new skills and how these skills will positively impact students, a key component of both trainings, they are more likely to implement the skills taught (Bredeson et al., 1983; Englert & Tarrant, 1995; Guskey, 1989). In addition, our goal for both trainings was to ensure the new skills were flexible, low in complexity, and familiar to teachers (e.g. deep breathing) which may be an additional reason for the elevated levels of satisfaction.

In contrast to our hypothesis, however, there were no differences between the two trainings in levels of satisfaction, despite the fact that the TAPES training included active learning approaches such as modeling, and rehearsal/role plays which are associated with enhanced learning (Beidas & Kendall, 2010; Fixsen et al., 2005; Sholomskas et al., 2005). One interpretation of this finding is that both trainings offered new and important information to teachers and included access to materials to support implementation (e.g. handouts, resources), which may have increased the satisfaction of the teachers receiving TAT. The high level of satisfaction with the brief TAT training suggests that future trainings may be as effective using automated, virtual, and asynchronous options, which would allow access to the training to a broader population of teachers and be less costly. Specifically, while the current study was conducted in the United States, teachers in other countries, and particularly teachers working in low-resourced countries, may benefit from a similar brief training on student anxiety.

Teacher Knowledge and Use of Anxiety Reduction Strategies. Consistent with extant literature, teachers’ average score on the knowledge of anxiety exam was low (on average 56% correct) prior to training, demonstrating a limited fount of information related to identifying signs of student anxiety as well as knowledge of evidence-based anxiety reduction strategies. At post-training (i.e. 8–10 weeks after training), regardless of training received, teachers’ scores improved significantly (i.e. by over 20%). Consistent with our hypothesis, teachers receiving TAPES showed greater increases in their knowledge (scores at post-assessment were 84% for TAPES and 76% for TAT). Taken together, however, these results suggest that even a brief three-hour didactic training can have a meaningful impact on teacher knowledge. A longer more interactive training appears to confer additional benefits in terms of enhancing knowledge.

With respect to the use of anxiety reduction skills in the classroom, teachers in both trainings reported a significant increase in the frequency of using skills such as relaxation skills (e.g. deep breathing, progressive muscle relaxation, and a calm down corner), coping self-talk (e.g. encouraging students to use coping self-talk and modeling it for students), supporting students in facing (rather than avoiding) anxiety-provoking situations and increasing their autonomy/independence (rather than seeking reassurance), and promoting a collaborative and prosocial classroom environment (e.g. focusing on teamwork rather than competitive activities). Impressively, the effect sizes of changes in both knowledge and use of anxiety reduction strategies were medium to large (with most values greater than d = 0.5).

Pre-post training effects in teachers' use of accommodation of their student's anxiety also improved. Specifically, teachers in TAPES reported. Specifically, teachers reported that they were less likely to modify classroom activities to accommodate their student's anxiety, assist the student in avoiding things that might make them anxious, do things that are normally the students’ responsibility, or modify their work schedule (e.g. lunch, planning period) due to their student's anxiety. These types of activities by parents (i.e. accommodation of anxiety), have been associated with higher child anxiety and are often a key component of interventions to reduce anxiety (Thompson-Hollands et al., 2014). As noted, in a recent study, greater teacher accommodation of avoidance was associated with higher levels of students’ behavioral avoidance and anxiety severity (Ginsburg et al., 2023), highlighting the importance of addressing this teacher behavior in training.

Teacher Confidence and Self-efficacy. Teachers receiving either training reported significant increases in their perceived confidence to effectively implement anxiety reduction strategies for students as well as in their ability to motivate students low in interest, help students believe they can do well at school, control disruptive behaviors in the classroom and get students to follow rules or to calm a student who is noisy or disruptive. Teachers receiving TAPES (but not TAT) also reported greater efficacy in using effective instructional strategies such as providing alternative explanations or examples if a child is confused, crafting good questions, and using a variety of assessment strategies (based within-group analyses).

These findings are consistent with the theoretical models of Han and Weiss (2005) and Guskey (2002) which detail the mechanisms of teacher behavior change in adopting mental health interventions. Specifically, the current findings suggest that the trainings improved a key teacher characteristic (i.e. self-efficacy and confidence) that has been linked to higher rates of implementation and sustained use of new skills (Stein & Wang, 1988; Tschannen-Moran & Hoy, 2001). That is, training can promote behavior change when it enhances teachers’ understanding of and beliefs that the new skills (a) will solve an important student problem, (b) are efficacious, and (c) are compatible with their teaching style and beliefs about children's behavior (Kealey et al., 2000).

Limitations and future directions

The results of this study should be interpreted in the context of several study limitations. The sample of teachers was comprised of volunteers, and they were relatively homogenous in terms of geographic region, race, ethnicity, gender, and school type (elementary schools only), thus restricting the generalizability of results. Additionally, the study utilized some measures that were modified or developed for the current study and have not been empirically validated (e.g. the internal consistency of the Classroom Strategies Questionnaire was .62, which may be a result of poor reliability or small sample size). The impact of the trainings was evaluated using teacher self-reports and may not reflect changes in actual behavior. Future studies using observational data on teachers’ use of classroom strategies are needed. In addition, the impact of the trainings was examined eight to ten weeks after the training, thus the longer-term impact of the trainings is unknown. Finally, future evaluation of these trainings on student anxiety and academic functioning is needed.

In summary, enhancing the capacity of teachers to identify and assist students with anxiety in their classroom via brief trainings shows promise. The improvements in teacher knowledge, skills, confidence, and perceived self-efficacy and reductions in self-reported accommodation of student anxiety suggest that teachers’ benefit even from brief trainings. School districts may benefit from exploring ways to increase access to and offerings of these types of trainings via online platforms for their teachers.

Footnotes

Compliance with ethical standards

This research was approved by the University of Connecticut School of Medicine's Institutional Review Board. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Declaration of conflicting interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This research was supported by the Institute of Education Sciences, U.S. Department of Education, through Grant # R324A170071 to the University of Connecticut School of Medicine. The opinions expressed are those of the authors and do not represent the views of the Institute or the U.S. Department of Education.

Informed consent

Informed consent was obtained from all participants.

ORCID iDs

Golda S. Ginsburg

Jeffrey E. Pella

Grace Chan

Author biographies

Golda S. Ginsburg is a Professor of Psychiatry and has been developing and evaluating trainings and interventions for youth with anxiety for over 20 years. She was the PI of the TAPES development grant and has completed or is running several school-based studies designed to help students with anxiety.

Jeffrey E. Pella is an Assistant Professor of Psychiatry in the Department of Psychiatry and has been working in the field of developmental psychopathology and child anxiety for 12 years. He has over 8 years' experience working extensively with school clinicians, teachers, principals. He is Co-PI of the TAPES study.

Anneliese DeVito, BA is a UConn graduate and research assistant who has assisted in recruiting, enrolling and managing data for the current study.

Grace Chan is an Assistant Professor Department of Psychiatry and Public Health Sciences, University of Connecticut School of Medicine. Her background is in mathematical statistics and she had been collaborating on numerous school-based and mental health-related research projects as a statistician.

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