Journal of Child and Family Studies

, Volume 27, Issue 10, pp 3300–3315 | Cite as

Adapting the Brief Coping Cat for Children with Anxiety to a Group Setting in the Spanish Public Mental Health System: a Hybrid Effectiveness-Implementation Pilot Study

  • Olga Santesteban-EcharriEmail author
  • Laura Hernández-Arroyo
  • Simon M. Rice
  • M. José Güerre-Lobera
  • María Serrano-Villar
  • José Carlos Espín-Jaime
  • Miguel Ángel Jiménez-Arriero
Original Paper


Group therapy may offer a promising solution to reducing patient waiting lists for publicly funded mental health services. In this study, an individual brief cognitive behavioral therapy (BCBT) intervention was adapted for implementation in a group setting in the Spanish public mental health care system. The study was designed to test initial clinical effectiveness, acceptability, and feasibility of the group adaptation of BCBT for child anxiety. The study utilized an uncontrolled multiple-group design for 8 weeks (1 h per week). Inclusion criteria were (i) children and young adolescents between 8 and 15 years old, and (ii) a clinical diagnosis of general anxiety disorder, social phobia, and/or separation anxiety disorder. Five groups were completed (n = 33; mean age = 11 years; 42.4% females). A total of 31 (93.9%) participants completed at least 7 sessions, and follow-up data were collected for 84.9% (n = 28) of participants. Overall, anxiety symptoms were reduced after intervention on the Spence Children Anxiety Scale, Generalized Anxiety Disorder Questionnaire-IV, Social Anxiety Scale for Children-Revised, and Separation Anxiety Symptom Inventory. Our findings suggest that group BCBT was associated with beneficial treatment outcomes, was acceptable and feasible for children with anxiety in the Spanish public mental health system. Both participants and their caregivers reported satisfaction and feelings of safety with the intervention. Results underscore the need for a larger-scale hybrid effectiveness-implementation trial of BCBT in a group setting throughout more community mental health centers in different Spanish states. Such work could improve patient access to and benefit from an evidence-based treatment that works in community settings.


Anxiety Brief cognitive-behavioral therapy Exposure Coping cat Generalized anxiety disorder Separation anxiety disorder Social phobia 



The authors acknowledge all the clinicians involved in providing the intervention as co-therapists: David Rentero-Martin, Patricia Nava-García, Sergio Benavente-López, Esther Martín-Ávila, Odei Iriondo-Villaverde, Manuel Nieves-Carnicer, and the rest of child and adolescent clinicians from the Mental Health Centers Villaverde and Carabanchel for assisting with participant recruitment. Finally, the authors would like to thank all the participating children and their families for their involvement with the intervention.


O.S.-E., the first author, was supported by a Research Fellowship from the Alicia Koplowitz Foundation (Spain) and an Endeavour Research Fellowship (Australia). S.M.R. was supported via the Mary Elizabeth Watson Early Career Fellowship in Allied Health, provided by Melbourne Health.

Author Contributions

O.S.-E.: designed and executed the study, analyzed the data, and wrote the paper. L.H.-A.: collaborated with the design and execution of the study as a co-therapist of the groups. S.M.R.: assisted with the analyses and editing of the study. M.J.G.-L., M.S.-V., and J.C.E.-J.: collaborated with the design and writing of the study. M.A.J.-A.: collaborated in the editing of the final manuscript.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.


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Copyright information

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Authors and Affiliations

  • Olga Santesteban-Echarri
    • 1
    • 2
    Email author
  • Laura Hernández-Arroyo
    • 1
  • Simon M. Rice
    • 3
    • 4
  • M. José Güerre-Lobera
    • 1
  • María Serrano-Villar
    • 5
  • José Carlos Espín-Jaime
    • 1
  • Miguel Ángel Jiménez-Arriero
    • 1
  1. 1.Hospital Universitario 12 de OctubreMadridSpain
  2. 2.Facultad de Ciencias de la Salud, Universidad Internacional de la Rioja (UNIR)MadridSpain
  3. 3.Orygen, The National Centre of Excellence in Youth Mental HealthMelbourneAustralia
  4. 4.Centre for Youth Mental Health, The University of MelbourneMelbourneAustralia
  5. 5.Instituto Psiquiátrico José Germain de LeganesMadridSpain

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