CATS: CBT for Anxiety Treatment in Schools

Students in grades K–8 struggling with anxiety

For children/adolescents ages: 5 - 13

CATS: CBT for Anxiety Treatment in Schools is a group-based program for students in Grades K–8. The eight-session curriculum teaches children to recognize anxious thoughts, manage physical signs of worry, think flexibly, and face fears gradually through guided “I CAN” steps—Identify, Choose, Act, and Now try it. Implemented by school counselors, psychologists, or behavioral health staff, CATS is designed to integrate easily into the school day, using engaging, developmentally appropriate activities that foster emotional awareness and coping skills. By embedding cognitive-behavioral principles within educational settings, CATS is designed to treat anxiety, promote resilience, and help schools support the mental health and learning success of all students.

Vanessa Winters, PhD

• Agency/Affiliation: Workbook Publishing Inc.
• Website: https://www.workbookpublishing.com
• Email: websales@workbookpublishing.com

The goals of CATS: CBT for Anxiety Treatment in Schools are:

• Recognize and label emotions in themselves and others to increase emotional awareness.
• Understand the body’s anxiety response (e.g., “fight, flight, or freeze”) and identify personal signs of worry.
• Identify anxious and unhelpful thoughts that contribute to fear and avoidance.
• Challenge unhelpful thinking and replace with more helpful, realistic thoughts.
• Develop relaxation and coping strategies (e.g., deep breathing, mindfulness) to manage anxiety symptoms.
• Face feared situations gradually and safely, using guided “I CAN” exposure practices.
• Increase confidence and self-efficacy in handling everyday challenges and uncertain situations.
• Strengthen problem-solving and goal-setting skills for academic and social situations.
• Improve emotional regulation and classroom participation through consistent coping practice.
• Build resilience and adaptability, applying coping skills across home, school, and peer contexts.

The essential components of CATS: CBT for Anxiety Treatment in Schools include:

• Basic Elements:
  • Structured, school-based, cognitive-behavioral program
  • Designed for small group delivery by school mental health professionals
  • Consists of eight 35- to 40-minute sessions
  • Delivered weekly or biweekly, with optional booster or parent sessions.
  • Each session follows a consistent format integrating:
    • Psychoeducation
    • Skill-building
    • Practice
• Program Structure and Delivery
  • Setting: Implemented within school settings (e.g., counseling office, classroom, or resource room) during the school day or after school
  • Format: Group-based intervention; optimal group size of 6–8 students
  • Facilitators: Delivered by trained school-based providers:
    • Counselors
    • Psychologists
    • Social workers
    • Behavioral health staff
    • Duration: Eight core sessions (35–40 minutes each), with optional booster and/or parent sessions
    • Materials:
      • CATS Implementer Manual – step-by-step facilitator guide.
      • CATS Student Workbook – student activities, worksheets, and practice tools
    • Instructional Approach: Highly structured sessions using:
      • Modeling
      • Role-play
      • Guided discussion
      • Experiential practice
• Core Program Components:
  • Building Emotional Awareness
    • Introduce the concept of emotions and how they are expressed (“feelings charades,” “feelings thermometer”)
    • Teach students to label and differentiate emotions using developmentally appropriate language and visuals
    • Normalize anxiety as a common, manageable emotion
  • Understanding the Anxiety Response:
    • Teach the “fight, flight, or freeze” model and how physical sensations relate to worry
    • Help students identify personal “body clues” of anxiety (e.g., stomachache, heart racing)
    • Discuss “false alarms” and when anxiety may be unhelpful
  • Cognitive Skills – Recognizing and Challenging Thoughts:
    • Introduce the “I CAN” steps:
      • I – Identify my feelings and thoughts
      • C – Choose how I want to think and feel
      • A – Actions that will get me closer to my goal
      • N – Now try it
    • Teach the difference between helpful and unhelpful thoughts
    • Practice generating alternative, realistic thoughts through group discussion and structured worksheets
  • Relaxation and Coping Skills:
    • Teach and practice basic relaxation strategies such as deep breathing, grounding, and progressive muscle relaxation.
    • Integrate short mindfulness or “relaxation” exercises suitable for classroom use.
    • Reinforce daily practice between sessions.
  • Behavioral Skills – Facing Fears Gradually:
    • Teach students to face, rather than avoid ,feared situations using step-by-step “I CAN Practices”
    • Guide students in creating individualized fear hierarchies (i.e., graded exposure plans)
    • Conduct in-session or school-based exposure practice (e.g., raising hand in class, joining group play)
  • Problem Solving and Goal Setting:
    • Introduce structured problem-solving steps:
    • Identify the problem
    • Brainstorm options
    • Choose an action
    • Evaluate outcomes
    • Reinforce persistence and effort through small, achievable goals and reward systems
  • Reinforcement and Motivation:
    • Use positive reinforcement for participation and skill use:
      • Stickers
      • Points
      • Verbal praise
    • End each session with a brief, fun group activity to strengthen engagement and group cohesion
    • Encourage sharing of progress and success stories in each session
  • Skill Generalization and Maintenance:
    • Encourage students to apply coping skills in multiple settings (classroom, home, sports, community)
    • Review and consolidate “I CAN” steps in the final sessions
    • Develop individualized “My I CAN Plan” for continued use after program completion
• Optional and Supplemental Components:
  • Parent/Educator Session: One optional session to:
    • Introduce program concepts
    • Anxiety education
    • Strategies for supporting children’s coping at home and school
  • Booster Sessions: Optional follow-up meetings (2–3 sessions) to reinforce and maintain skills over time
  • Teacher Collaboration: Encourage brief communication between facilitator and classroom teacher to support skill practice and reinforcement in the classroom
• Distinctive Features:
  • Structured CBT curriculum adapted for school delivery with simplified, developmentally tailored language
  • I CAN framework unique to CATS, offering an easy-to-remember sequence
  • Designed for nonspecialist implementers in educational settings, with clear session scripts and reproducible student materials
  • Incorporates interactive learning and concrete visual tools to engage all types of learners

Child/Adolescent Services

CATS: CBT for Anxiety Treatment in Schools directly provides services to children and addresses the following:

• Excessive worry, fear, or nervousness 
• Avoidance of school, social, or performance situations 
• Physical symptoms of anxiety (e.g., stomachaches, headaches, tension) 
• Difficulty concentrating or completing schoolwork due to worry 
• Restlessness, irritability, or fatigue linked to anxiety 
• Perfectionism or excessive reassurance-seeking 
• Social withdrawal or reluctance to separate from caregivers 
• Low confidence in managing new or uncertain situations 

Recommended Intensity

Eight 35- to 40-minute sessions ideally offered weekly or biweekly

Recommended Duration

Brief – 2 months

Delivery Settings

This program is typically conducted in a(n):

• School Setting (Including: Day Care, Day Treatment Programs, etc.)

Homework

This program does include a homework component.

Review and Practice activities are assigned for between group homework.

Resources Needed to Run Program

The typical resources for implementing the program are:

• Personnel
  • One trained school-based mental health professional (e.g., counselor, psychologist, social worker, or behavioral health staff) to lead each group.
  • Optional support staff member for classroom coordination or scheduling.
• Space:
  • Quiet, private room within the school (e.g., counseling office, small group room, or classroom area) large enough for 6–8 students to sit in a circle or around a table.
  • Comfortable seating and workspace for student activities and role-plays.
• Materials and Supplies:
  • CATS Implementer Manual and CATS Student Workbooks (one per participant).
  • Basic art or school supplies (e.g., paper, markers, pencils, stickers, folders).
  • Visual aids such as a whiteboard, flip chart, or projector (optional) for demonstrating CBT concepts.
• Session Logistics:
  • Approximately 35–40 minutes per session, scheduled weekly or biweekly during the school day
  • Consistent meeting time to allow students to participate without academic disruption

Prerequisite/Minimum Provider Qualifications

• Education:
  • Bachelor’s-level school staff (e.g., guidance counselors, behavioral specialists) and mental health professionals with MA or higher degree may implement the CATS program
• Experience:
  • Prior experience working with children or adolescents in school, clinical, or community settings
  • Basic familiarity with child development, classroom management, and student support practices
  • Previous exposure to cognitive-behavioral or skills-based interventions is recommended but not required
• Professional Role:
  • Typically implemented by school psychologists, counselors, social workers, or behavioral health staff within school system

Manual Information

There is a manual that describes how to deliver this program.

Program Manual(s)

Manual details:

• Khanna, M. S., Eiraldi, R. B., & Kendall, P. C. (2025). CBT for Anxiety Treatment in Schools (CATS): Implementer Manual (K–8). Workbook Publishing, Inc.
• Khanna, M. S., Eiraldi, R. B., & Kendall, P. C. (2025). CATS: CBT for Anxiety Treatment in Schools – Student Workbook (K–8). Workbook Publishing, Inc.

Access Information:
Manuals and workbooks are available through Workbook Publishing, Inc. and may be obtained by contacting the publisher or program developer directly:

Website: www.workbookpublishing.com
Email: info@workbookpublishing.com

Training Information

There is training available for this program.

Training Contact

Training Type/Location:

Delivery Options: Live virtual, in-person, or hybrid workshops

Format: Interactive didactic instruction, video demonstrations, role-play, and guided practice

Group Size: Typically 10–25 participants per training cohort

Optional live virtual ongoing consultation calls (60 minutes each) offered during initial implementation phase to support fidelity, case review, and troubleshooting

Number of days/hours:

Standard training workshop: 6–8 hours (1 full-day or two half-day sessions) which includes orientation to CBT for child anxiety, CATS structure, session-by-session review, and implementation planning
Optional live virtual ongoing consultation calls (60 minutes each) offered during implementation phase to support fidelity, case review, and troubleshooting

Pre-Implementation Materials

There are no pre-implementation materials to measure organizational or provider readiness for CATS: CBT for Anxiety Treatment in Schools.

Formal Support for Implementation

There is formal support available for implementation of CATS: CBT for Anxiety Treatment in Schools as listed below:

Optional live virtual ongoing consultation calls (60 minutes each) are offered to support fidelity, case review, and troubleshooting.

Fidelity Measures

There are fidelity measures for CATS: CBT for Anxiety Treatment in Schools as listed below:

CATS Session Fidelity Checklist:
A session-by-session checklist completed by the facilitator or supervisor to document whether essential components (e.g., review, new skill instruction, practice, group discussion, and “I CAN” application) were delivered as intended:

• Fidelity is typically assessed through self-report checklists and supervisory observation (either in person or via recorded sessions).
• Ratings capture adherence (completion of key steps) and competence (quality of delivery)
• Tools are scored using a simple 3-point Likert scale (e.g., not completed, partially completed, fully completed)

For access or permission to use fidelity measures, contact the Training Contact above.

Established Psychometrics

Eiraldi,R., Lawson, G. A., Glick, H. A., Khanna, M. S., Beidas, R., Fishman, J.,  Rabenau-McDonnell, Q., Wilson, T., Comly, R., Schwartz, B. S., & Jawad, A. F. (2024). Implementation fidelity, student outcomes, and cost-effectiveness of train-the-trainer strategies for Masters-level therapists in urban schools: Results from a cluster randomized trial. Implementation Science, 19, Article 4.  https://doi.org/10.1186/s13012-023-01333-9 

Implementation Guides or Manuals

There are implementation guides or manuals for CATS: CBT for Anxiety Treatment in Schools as listed below:

The CATS Implementer Manual provides a complete, session-by-session guide for delivering the eight-session, school-based CBT group program for students in Grades K–8. It includes clear instructions, scripts, worksheets, and activities that help children identify anxious thoughts, learn coping skills, and face fears gradually through the “I CAN” steps (Identify, Choose, Act, Now try it). The manual outlines objectives, materials, and discussion prompts for each session, along with optional parent and teacher involvement activities, fidelity checklists, and reproducible handouts. A companion CATS Student Workbook contains parallel child-friendly materials and practice exercises.

• Khanna, M. S., Eiraldi, R. B., & Kendall, P. C. (2025). CBT for Anxiety Treatment in Schools (CATS): Implementer Manual (K–8). Workbook Publishing, Inc.
• Khanna, M. S., Eiraldi, R. B., & Kendall, P. C. (2025). CATS: CBT for Anxiety Treatment in Schools – Student Workbook (K–8). Workbook Publishing, Inc.

Access Information:
Manuals and workbooks are available through Workbook Publishing, Inc. and may be obtained by contacting the publisher or program developer directly:

Website: www.workbookpublishing.com
Email: info@workbookpublishing.com

Implementation Cost

There have been studies of the costs of implementing CATS: CBT for Anxiety Treatment in Schools which are listed below:

Research on How to Implement the Program

Research has been conducted on how to implement CATS: CBT for Anxiety Treatment in Schools as listed below:

Eiraldi, R., Comly, R., Goldstein, J., Khanna, M. S., McCurdy, B. L., Rutherford, L. E., Henson, K., Bevenour, P. Francisco, J., & Jawad, A. F (2023). Development of an online training platform and implementation strategy for school-based mental health professionals in rural elementary schools: A mixed-methods study. School Mental Health, 15, 692–709. https://doi.org/10.1007/s12310-023-09582-1 

Eiraldi, R., Comly, R., Wolk, C. B., Rabenau-McDonnell, Q., McCurdy, B. L., Khanna, M. S., Jawad, A. F., Banks, J., Clark, S., Popkin, K. M., Wilson, T., & Henson, K. (2024). Preparation for implementation of evidence-based practices in urban schools: A shared process with implementing partners.  Implementation Research and Practice, 5. https://doi.org/10.1177/26334895241279503  

Eiraldi, R., Lawson, G. M., Glick, H. A., Khanna, M. S., Beidas, R., Fishman, J., Rabenau-McDonnell, Q., Wilson, T., Comly, R., Schwartz, B. S., & Jawad, A. F. (2024). Implementation fidelity, student outcomes, and cost-effectiveness of train-the-trainer strategies for Masters-level therapists in urban schools: results from a cluster randomized trial. Implementation Science, 19, Article 4. https://doi.org/10.1186/s13012-023-01333-9

Lawson, G. M., Comly, R., Beidas, R. S., Khanna, M. S., Goldstein, J., Goldstein, J., Brizzolara-Dove, S., Wilson, T., Rabenau-McDonnell, Q., & Eiraldi, R. (2023). Therapist and supervisor perspectives about two train-the-trainer implementation strategies in schools: A qualitative study. Implementation Research and Practice, 4. https://doi.org/10.1177/26334895231190854 

Child Welfare Outcome: Child/Family Well-Being

What is included in the Relevant Published, Peer-Reviewed Research section?

• Author: Lawson, G. M., Jawad, A. F., Comly, R., Khanna, M., Glick, H. A., Beidas, R. S., Goldstein, J., Brizzolara-Dove, S., Wilson, T., Rabenau-McDonnell, Q., & Eiraldi, R. (2023). A comparison of two group cognitive behavioral therapy protocols for anxiety in urban schools: Appropriateness, child outcomes, and cost-effectiveness. Frontiers in Psychiatry, 14, Article 1105630. https://doi.org/10.3389/fpsyt.2023.1105630 

  Type of Study: Randomized controlled trial

  Sample:

  Age — Therapists: Not specified; Children: Mean=10.93 years

  Participants: 91

  Race/Ethnicity — Therapists: Not specified; Children: 63% Black, 29% Hispanic, 13% White, and 5% Multiple Races

  Gender — Therapists: Not specified; Children: 66% Male

  Status — Participants were therapists and supervisors working with students in 4th–8th grade with anxiety.

  Location/Institution: Urban schools in the United States

  Summary:

  Summary: The purpose of the study was to compare the effectiveness, cost-effectiveness, and perceived appropriateness of FRIENDS and CATS [now called CATS: CBT for Anxiety Treatment in Schools] when delivered by Master’s-level therapists with train-the-trainer support. Participants were randomized to either FRIENDS or CATS. Measures utilized include Multidimensional Anxiety Scale for Children – 2nd Edition (MASC-2), Engagement versus Disaffection with Learning-Teacher Report (EvsD-Teacher), logs that recorded the time therapists spent on activities with students, data on therapist hourly wage/annual salaries, and semi-structured interviews that explored therapist perception of the group treatment sessions and the type of support that therapists and supervisors received. Results indicate that the mean change score for the child-reported MASC-2 was 1.9 points in the FRIENDS condition and 2.9 points in the CATS condition. Results also indicate that the conditions were similar in their treatment effects, and symptom reductions were small in both groups. The modified protocol, CATS, was shown to cost significantly less to implement compared to FRIENDS and showed greater cost-effectiveness. Finally, compared to therapists and supervisors in the CATS condition, therapists and supervisors in the FRIENDS condition more strongly described aspects of the intervention that were not appropriate for their context and in need of more extensive adaptations. Limitations include the premature halting of group interventions due to COVID‑19, which reduced completion rates and may have influenced outcomes; substantial missing parent‑report data; inconsistent intervention dosage caused by student absences and scheduling constraints; considerable variation in group sizes and cohorts across schools; a small sample size; and a lack of follow-up. 

  Length of controlled postintervention follow-up: None

• Lawson, G. M., Comly, R., Beidas, R., S., Khanna, M. S., Goldstein, J., Brizzolara-Dove, S., Wilson, T., Rabenau-McDonnell, Q., & Eiraldi, R. (2023). Therapist and supervisor perspectives about two train-the-trainer implementation strategies in schools: A qualitative study. Implementation Research and Practice, 4. https://doi.org/10.1177/26334895231190854

• Eiraldi, R., McCurdy, B. I., Khanna, M. S., Goldstein, J., Comly, R., Francisco. J., Rutherford, L. E., Wilson, T., Henson, K., Farmer, T., & Jawad, A. F. (2022). Development and evaluation of a remote training strategy for the implementation of mental health evidence-based practices in rural schools: Pilot study protocol. Pilot and Feasibility Studies, 8(1), Article 128. https://doi.org/10.1186/s40814-022-01082-4