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Comparing different modes of delivery

A pilot evaluation of a family-focused, cognitive-behavioral intervention for anxiety-disordered children

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Abstract

Cognitive behavior therapy delivered by trained clinicians has been shown to be an effective treatment for childhood anxiety. However, the prevalence of anxiety disorders in children and adolescents, combined with the practical and psychological obstacles that often prevent families from accessing professional help, mean that alternative ways of reaching prospective clients must be explored. This pilot study aims to compare the relative efficacy of two different modes of delivering a family-focused, cognitive-behavioral intervention for children with an anxiety disorder. The two modalities compared were: a parent-delivered program (bibliotherapy) and a clinician-delivered program (individual therapy). Twenty-seven children aged between 7 and 14, together with their parents, were randomly assigned to one of the two conditions listed above. Results at post-treatment showed a significant improvement for children in both treatment conditions in terms of diagnostic status, number of diagnoses and severity of primary diagnosis at follow-up. Children in the bibliotherapy condition demonstrated a significant improvement over time in terms of child- and parent-reported anxiety levels. No differences were found between the two treatment conditions on any outcome measure. These results were maintained at 3- and 6-month follow-up. Although a pilot study, these data suggest that a bibliotherapy format of the intervention described may have potential merit. The implications for service delivery are discussed, as are the limitations of this research.

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References

  1. Achenbach TM (1991) Integrative guide to the 1991 CBCL/4-18, YSR, and TRF profiles. University of Vermont, Department of Psychology, Burlington, VT

  2. American Psychiatric Association (1994) Diagnostic and statistical manual of mental disorders. American Psychiatric Association, Washington D.C.

    Google Scholar 

  3. Barrett PM, Dadds MR, Rapee RM (1996) Family treatment of childhood anxiety: a controlled trial. J Consult Clin Psychol 64:333–342

    Article  PubMed  CAS  Google Scholar 

  4. Cartwright-Hatton S, Roberts C, Chitsabesan P, Fothergill C, Harrington R (2004) Systematic review of the efficacy of cognitive-behaviour therapies for childhood and adolescent anxiety disorders. Br J Clin Psychol 43:421–436

    Article  PubMed  Google Scholar 

  5. Cobham VE (2001) Do as I do program: parents’ workbook. University of Queensland Psychology Clinic, Queensland

    Google Scholar 

  6. Cobham VE (2001) Facing your fears program: children’s workbook. University of Queensland Psychology Clinic, Queensland

    Google Scholar 

  7. Cobham VE, Dadds MR, Spence SH (1998) The role of parental anxiety in treatment of childhood anxiety. J Consult Clin Psychol 66(6):893–905

    Article  PubMed  CAS  Google Scholar 

  8. Cole DA, Truglio R, Peeke L (1997) Relation between symptoms of anxiety and depression in children: A multitrait-multimethod-multigroup assessment. J Consult Clin Psychol 65:110–119

    Article  PubMed  CAS  Google Scholar 

  9. Compton SN, Burns BJ, Egger HL, Robertson E (2002) Review of the evidence base of treatment of childhood psychopathology: internalizing disorders. J Consult Clin Psychol 70:1240–1266

    Article  PubMed  Google Scholar 

  10. Essau CA, Conradt J, Petermann F (2002) Course and outcome of anxiety disorders in adolescents. J Anxiety Disord 16:67–81

    Article  PubMed  Google Scholar 

  11. Farrell LJ, Barrett PM, Claasens S (2006) Community trial of an evidence-based anxiety intervention for children and adolescents (the FRIENDS Program): a pilot study. Behav Change 22(4):236–248

    Article  Google Scholar 

  12. Ginsburg GS, Siqueland L, Masia-Warner C, Hedtke KA (2004) Anxiety disorders in children: family matters. Cogn Behav Pract 11:28–43

    Article  Google Scholar 

  13. Goodman R (1997) The strengths and difficulties questionnaire: a research note. J Child Psychol Psychiatry 38:581–586

    Article  PubMed  CAS  Google Scholar 

  14. Goodman R, Scott S (1999) Comparing the strengths and difficulties questionnaire and the child behavior checklist: is small beautiful? J Abnorm Child Psychol 27:17–24

    Article  PubMed  CAS  Google Scholar 

  15. Goodman R (2001) Psychometric properties of the strengths and difficulties questionnaire (SDQ). J Am Acad Child Adolesc Psychiatry 40:1337–1345

    Article  PubMed  CAS  Google Scholar 

  16. Griffiths JD, Martin Pr (1996) Clinical- versus home-based treatment formats for children with chronic headache. Br J Health Psychol 1:151–166

    Google Scholar 

  17. Hodges B, Craven J, Littlefield C (1995) Bibliotherapy for psychosocial distress in lung transplant patients and their families. Psychosomatics 36:360–368

    PubMed  CAS  Google Scholar 

  18. Kubiszyn T, Carlson JC, DeHay T (2005) Developments in pediatric psychopharmacology: an update on internalizing disorders. Sch Psychol Q 20(2):135–154

    Article  Google Scholar 

  19. Loeb KL, Wilson G, Gilbert JS, Labouvie E (2000) Guided and unguided self-help for binge-eating. Behav Res Ther 38:259–272

    Article  PubMed  CAS  Google Scholar 

  20. Lyneham HJ, Rapee RM (2006) Evaluation of therapist-supported parent-implemented CBT for anxiety disorders in rural children. Behav Res Ther 44:1287–1300

    Article  PubMed  Google Scholar 

  21. Mains JA, Scogin FR (2003) The effectiveness of self-administered treatments: a practice-friendly review of the research. J Clin Psychol 59(2):237–246

    Article  PubMed  Google Scholar 

  22. Marrs RW (1995) A meta-analysis of bibliotherapy studies. Am J Commun Psychol 23(6):843–870

    Article  CAS  Google Scholar 

  23. McKendree-Smith NL, Floyd M, Scogin FR (2003) Self-administered treatments for depression: a review. J Clin Psychol 59:275–288

    Article  PubMed  Google Scholar 

  24. Mendlowitz SL, Manassis K, Bradley S (1999) Cognitive-behavioral group treatments in childhood anxiety disorders: the role of parental involvement. J Am Acad Child Adolesc Psychiatry 38:1223–1229

    Article  PubMed  CAS  Google Scholar 

  25. Muris P, Steerneman P (2001) The Revised version of the screen for child anxiety related emotional disorders (SCARED-R): first evidence for its reliability and validity in a clinical sample. Br J Clin Psychol 40(1):35–44

    Article  PubMed  CAS  Google Scholar 

  26. Nauta MH, Scholing A, Emmelkamp PMG, Minderaa RB (2003) Cognitive-behavioral therapy for children with anxiety disorders in a clinical setting: no additional effect of a cognitive parent training. J Am Acad Child Adolesc Psychiatry 42:1270–1278

    Article  PubMed  Google Scholar 

  27. Newman MG, Erickson T, Preworski A, Dzus E (2003) Self-help and minimal-contact therapies for anxiety disorders: is human contact necessary for therapeutic efficacy? J Clin Psychol 59:251–274

    Article  PubMed  Google Scholar 

  28. Nordahl HM, Ingul JM, Nordvik H, Wells A (2007) Does maternal psychopathology discriminate between children with DSM-IV generalized anxiety disorder or oppositional defiant disorder? The predictive validity of maternal axis I and axis II psychopathology. Eur Child Adolesc Psychiatry 16:87–95

    Article  PubMed  Google Scholar 

  29. Pine D, Cohen P, Gurley D, Brook J, Ma Y (1998) Risk for early-adulthood anxiety and depressive disorders in adolescents with anxiety and depressive disorders. Arch Gen Psychiatry 55:56–64

    Article  PubMed  CAS  Google Scholar 

  30. Rapee RM, Abbott MJ, Lyneham HJ (2006) Bibliotherapy for children with anxiety disorders using written materials for parents: a randomized controlled trial. J Consult Clin Psychol 74(3):436–444

    Article  PubMed  Google Scholar 

  31. Rapee RM, Spence SH, Cobham VE, Wignall A (2000) Helping your anxious child: a step-by-step guide for parents. New Harbinger, Oakland

    Google Scholar 

  32. Rapee RM, Wignall A, Hudson JL, Schniering CA (2000) Treating anxious children and adolescents: an evidence-based approach. Harbinger Publications, Oakland

    Google Scholar 

  33. Reynolds CR, Richmond BO (1979) “What I think and feel”: the revised children’s manifest anxiety scale. J Pers Assess 43:281–283

    Article  PubMed  CAS  Google Scholar 

  34. Silverman WK, Albano AM (1996) The anxiety disorders interview schedule for children (DSM-IV). Psychol Corp, San Antonio

    Google Scholar 

  35. Silverman WK, Saavedra LM, Pina AA (2001) Test–retest reliability of anxiety symptoms and diagnoses with the anxiety disorders interview schedule for DSM-IV: child and parent versions. J Am Acad Child Adolesc Psychiatry 40(8):937–940

    Article  PubMed  CAS  Google Scholar 

  36. Spence SH (1998) A measure of anxiety symptoms among children. Behav Res Ther 36:545–566

    Article  PubMed  CAS  Google Scholar 

  37. Spence SH, Donovan C, Brechman-Toussaint M (2000) The treatment of childhood social phobia: the effectiveness of a social skills training-based, cognitive-behavioural intervention, with and without parental involvement. J Child Psychol Psychiatry Allied Discipl 41(6):713–726

    Article  CAS  Google Scholar 

  38. van Londen A, van Londen-Barentsen MW, van Son MJ, Mulder GA (1995) Relapse rate and subsequent parental reaction after successful treatment of children suffering from noctural enuresis: a 2.5 year follow-up of bibliotherapy. Behav Res Ther 33:309–311

    Article  PubMed  Google Scholar 

  39. Webster-Stratton C (1990) Long-term follow-up of families with young conduct problem children: from pre-school to grade school. J Clin Child Psychol 19:144–149

    Article  Google Scholar 

  40. Webster-Stratton C, Kolpacoff M, Hollinsworth T (1988) Self-administered videotape therapy for families with conduct problem children: comparison of two cost-effective treatments and a control group. J Consult Clin Psychol 56:558–566

    Article  PubMed  CAS  Google Scholar 

  41. Weems CF, Silverman WK, La Greca AM (2000) What do youth referred for anxiety problems worry about? Worry and its relation to anxiety and anxiety disorders in children and adolescents. J Abnorm Child Psychol 28:63–72

    Article  PubMed  CAS  Google Scholar 

  42. Witt JC, Heffer RW, Pfeiffer J (1990) Structured rating scales: a review of self-report and informant rating procedures, and issues. In: Reynolds CR, Kamphaus RW (eds) Handbook of psychological and educational assessment of children. Guilford Press, New York, pp 364–394

    Google Scholar 

  43. Wright J, Clum GA, Roodman A, Febbraro GA (2000) A bibliotherapy approach to relapse prevention in individuals with panic attacks. J Anxiety Disord 14(5):483–499

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. School of Psychology, University of Queensland, St Lucia, QLD, 4072, Australia

    Joyce Leong, Vanessa Elise Cobham PhD & Jules de Groot

  2. Kids in Mind Research, Mater Child and Youth Mental Health Services, South Brisbane, Brisbane, QLD, 4101, Australia

    Brett McDermott MD

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  1. Joyce Leong
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  2. Vanessa Elise Cobham PhD
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  3. Jules de Groot
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  4. Brett McDermott MD
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Correspondence to Vanessa Elise Cobham PhD.

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Leong, J., Cobham, V.E., de Groot, J. et al. Comparing different modes of delivery. Eur Child Adolesc Psychiatry 18, 231–239 (2009). https://doi.org/10.1007/s00787-008-0723-7

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  • DOI: https://doi.org/10.1007/s00787-008-0723-7

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