Anxiety and depression affect 20% of children globally, with heightened risk during periods of crisis and substantial burden in low-resource settings where specialist services are scarce. Universal school-based interventions delivered by supervised trainees could promote youth mental health at scale, yet evidence for brief programs remains limited. We evaluated a brief cognitive-behavioral program (BRAVE: Be Emotionally Aware, Recognize Thoughts, Accept Challenges, Voice Emotions, Explore Solutions) with guided narrative writing (GNT-W) versus drawing control (GNT-D) among rural Chinese adolescents. In this cluster-randomized trial, 211 Grade 5 students (95.5% participation; mean age 10.03 years (SD 0.31)) from four classes in Hubei Province received three BRAVE classroom sessions delivered by trainees, then were randomized by class to guided narrative writing or drawing for three additional sessions. Primary outcomes were anxiety and depression (RCADS-25) at baseline, post-BRAVE, post-intervention, and 3- and 6-month follow-up, analyzed using multilevel models. Retention exceeded 95%, and session adherence was over 95%. Both groups showed reduced anxiety after BRAVE (d = − 0.26). At 6-month follow-up, only GNT-W sustained anxiety reductions (mean difference, − 1.80; 95% CI − 3.35 to − 0.25, p = 0.02, d = − 0.22), while anxiety increased in GNT-D. Among high-symptom students, GNT-W yielded large, sustained reductions in anxiety (d = − 1.44) and depression (d = − 0.71) at 6 months, versus minimal change or worsening with GNT-D. A brief, school-based CBT program with structured narrative writing, delivered by supervised trainees, produced sustained reductions in anxiety among adolescents in resource-limited settings. This approach shows promise for addressing youth mental health treatment gaps where specialist services are scarce. clinicaltrials.gov Identifier: NCT06708442. https://clinicaltrials.gov/study/NCT06708442?id=NCT06708442&rank=1
Wang et al. (Thu,) studied this question.