# @juleswaller_ on Instagram

- **Type:** Image
- **Original URL:** https://www.instagram.com/p/DYdmgiGk3ey
- **Gondola URL:** https://gondola.cc/posts/65567413-juleswaller-instagram
- **Thumbnail:** https://img.gondola.cc/tr:w-,h-,fo-auto/postThumbnails/e311cd5187.jpg
- **Posted:** 2026-05-18T02:02:37.000+00:00
- **Account Owner:** Julie Waller (Jules) | School Refusal Support (@juleswaller_) — https://gondola.cc/juleswaller_

## Caption

I want to share research that stopped me in my tracks when I first found it.

The largest meta-analysis of school refusal treatment looked at eight studies and 435 children.

CBT improved attendance in some of them.
It did not reduce their anxiety.

The effect size for anxiety reduction? 
Statistically zero. 
Eight studies. 
Same result.

I’m not sharing this to attack therapists. 
The professionals recommending CBT are not bad at their jobs. They’re working within a system that funds what it measures - and CBT is measurable.

And to be clear - CBT and graded exposure have a place. They’re part of the picture. My books cover both.

But here’s what the system almost never addresses first:
The nervous system.

You cannot cognitive-restructure a body that is in alarm. 
CBT works - but only after the nervous system has learned what safe feels like. 

That’s the sequence the research now supports. 
And it’s the sequence almost nobody is talking about.

The Australian and New Zealand Journal of Psychiatry said in 2025 that families are navigating this without adequate clinical evidence to guide them.

That gap - the nervous system piece that comes before everything else - is what I built the Toolkit for.

Comment TOOLKIT below and I’ll send it to you.

- Jules ♥️

#schoolrefusal #schoolanxiety #kidsmentalhealth #schoolsucks #teenmentalhealth

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## Tags

schoolrefusal, schoolanxiety, teenmentalhealth, schoolsucks, kidsmentalhealth

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