Cognitive Behavioral Therapy and School Avoidance

In the third article in her series on mental health and tutoring, Hampton Tutors coach and UW Master of Social Work candidate Gina Nepa talks about how cogntitive behavorial therapy is helping students improve school attendance. 


As internal and external pressures escalate within schools, more and more children are opting to avoid school, and often isolate instead. This pattern of avoidance in turn affects appropriate developmental socialization, and delays the onset of effective coping mechanisms and executive functioning skills. A four-week implementation of cognitive behavioral therapy (CBT) among children who refused school attendance due to anxiety was found to not only produce instantaneous attendance improvements among 88 percent of students, but also illustrated long-term attendance consistency for 81 percent of students (King et al., 2001).

Cognitive behavioral therapy focuses on “correcting” the interactions between thoughts, feelings, and behaviors. The treatment is rooted in adapting negative cognitive beliefs that result in counterproductive behaviors; in order to modify unhelpful patterns, core beliefs about self must be changed (Benjamin et al., 2011). For school avoidance particularly, several CBT techniques can aid in reducing a child’s negative associations with school.

One clinically significant technique is Aversive Conditioning. This strategy relies on the use of “dissuasion” to provoke a child to lose interest in pursuing a counterproductive behavior (such as skipping a particular class). Instead of associating skipping Algebra class with a positive stimulus of avoiding a stressful exam, the child may be conditioned to associate skipping class with a negative stimulus, such as loss of time with friends.

The importance of incorporating CBT techniques with school-averse children early cannot be understated. The amygdala within the brain regulates vigilance, and many children are hypervigilant in their quests to confirm that school is a terrible, anxiety-ridden place. Neuroimaging studies post-CBT treatment concluded that the amygdala was thus “significant[ly] deactivated” when changing the associations children have to historically negative stimuli (such as school), mimicking results of individuals who had positive responses to antidepressants (Almeida et al., 2013).

An abundance of evidence to date thus confirms that school avoidance does not need to be a lifelong battle.

Almeida, A. G. D., Araujo Filho, G. M. D., Berberian, A. D. A., Trezsniak, C., Nery-Fernandes, F., Araujo Neto, C. A. & Oliveira, I. R. D. (2013). The impacts of cognitive-behavioral therapy on the treatment of phobic disorders measured by functional neuroimaging techniques: a systematic review. Revista Brasileira de Psiquiatria, 35(3), 279-283.

Benjamin, Puleo, Settipani, Brodman, Edmunds, Cummings, & Kendall. (2011). History of Cognitive-Behavioral Therapy in Youth. Child and Adolescent Psychiatric Clinics of North America, 20(2), 179-189.

King, N., Tonge, B., Heyne, D., Turner, S., Pritchard, M., Young, D., Rollings, S., Myerson, N., Ollendick, T. (2001). Cognitive-Behavioural Treatment of School-Refusing Children: Maintenance of improvement at 3- to 5-year follow-up. Scandinavian Journal of Behaviour Therapy,30(2), 85-89.

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Gina Nepa