Contingency management, self-control, and education support in the treatment of childhood phobic disorders: A randomized clinical trial

Johns Hopkins University, Baltimore, Maryland, United States
Journal of Consulting and Clinical Psychology (Impact Factor: 4.85). 11/1999; 67(5):675-87. DOI: 10.1037/0022-006X.67.5.675
Source: PubMed


This study evaluated the relative efficacy of an exposure-based contingency management (CM) treatment condition and an exposure-based cognitive self-control (SC) treatment condition relative to an education support (ES) control condition for treating children with phobic disorders. Eighty-one children and their parents completed a 10-week treatment program in which children and parents were seen in separate treatment sessions with the therapist, followed by a brief conjoint meeting. Children in both the CM and SC conditions showed substantial improvement on all of the outcome measures. These gains were maintained at 3-, 6-, and 12-month follow-ups. Interestingly, children in the ES condition also showed comparable improvements at posttreatment and at 3-, 6-, and 12-month follow-ups. Implications of the findings are discussed with respect to knowledge development and clinical practice.

14 Reads
    • "Children apply the skills in real-life situations to gain mastery over their anxiety.[12] Robust support has now been collected by independent researchers using various CBT formats.[1314151617181920] Nonetheless some researchers suggested that some maintaining factors associated with childhood anxiety are not addressed in typical CBT protocols, therefore, about 30-40% of anxious children participating in a CBT programs did not experience a significant reduction in anxiety symptoms.[2122] "
    [Show abstract] [Hide abstract]
    ABSTRACT: Background: Emotion-focused cognitive behavioral therapy (ECBT) is a new form of CBT with emotion regulation components. This form of treatment is suggested to be employed to improve dysregulation of anxiety and other kind of emotions in anxious children. This study observed and compared the effectiveness of CBT and ECBT on anxiety symptoms; sadness and anger management; and cognitive emotion regulation strategies in children with separation anxiety disorder (SAD). Materials and Methods: This study is a randomized clinical trial. Subjects were 30 children from 9 to 13-years-old (15 girls and 15 boys) with diagnosis of SAD, being randomly assigned to CBT, ECBT, and control groups (five girls and five boys in each group). Subject children in CBT group participated in 10-h weekly sessions within Coping Cat manual; whereas, subject children in ECBT group contributed in 12-h weekly sessions within ECBT. The control group received no treatment. The Screen for Child Anxiety Related Emotional Disorders (SCARED; child and parent forms), Children's Emotion Management Scale (CEMS; anger and sadness forms), and Cognitive Emotion Regulation Questionnaire (CERQ) tests administered to all subjects in pretest, posttest, and the follow-up measurement (3 months later). Analysis of covariance (ANCOVA) repeated measure and Kruskal-Wallis were applied to analyze data by Statistical Package for Social Sciences (SPSS) software package (v. 20). Results: CBT and ECBT; demonstrated no significant difference in reducing separation anxiety and total anxiety symptoms from parent and children's reports. ECBT effectively increased anger coping and decreased negative cognitive strategies and dysregulation of anger in children, both in posttest and follow-up. Also, ECBT reduced sadness dysregulation and increased sadness coping, though these significant advantages were lost in 3 months later follow-up. CBT reduced negative cognitive strategies in follow-up and increased sadness coping in posttest. None of treatments affected on anger and sadness inhibition and positive cognitive coping in separation anxious children. Conclusion: ECBT, in comparison with CBT; effectively improved emotion regulation strategies in children with separation anxiety.
    Journal of research in medical sciences 03/2014; 19(3):221-7. · 0.65 Impact Factor
  • Source
    • "Psychoeducation and support may be sufficient to help teachers cope more effectively with the problematic behaviors of their pupils. Indeed, Silverman et al. (1999) showed that an attention-control condition involving (child) educational support resulted in a reduction of anxiety comparable to " active " treatments (i.e., a child contingency management condition and a child self-control training condition). Similar results were found for a school-based preventive intervention trial for childhood anxiety (Miller et al., 2011). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Objective: In this randomized controlled trial, we investigated the effectiveness of a school-based targeted intervention program for disruptive behavior. A child-focused cognitive behavioral therapy (CBT) program was introduced at schools in disadvantaged settings and with active teacher support (ATS) versus educational teacher support (ETS) (CBT + ATS vs. CBT + ETS). Method: Screening (n = 1,929) and assessment (n = 224) led to the inclusion of 173 children ages 8-12 years from 17 elementary schools. Most of the children were boys (n = 136, 79%) of low or low-to-middle class socioeconomic status (87%); the sample was ethnically diverse (63% of non-Western origin). Children received CBT + ATS (n = 29) or CBT + ETS (n = 41) or were entered into a waitlist control condition (n = 103) to be treated afterward (CBT + ATS, n = 39, and CBT + ETS, n = 64). Effect sizes (ES), clinical significance (reliable change), and the results of multilevel modeling are reported. Results: Ninety-seven percent of children completed treatment. Teachers and parents reported positive posttreatment effects (mean ES = .31) for CBT compared with the waitlist control condition on disruptive behavior. Multilevel modeling showed similar results. Clinical significance was modest. Changes had remained stable or had increased at 3-months follow-up (mean ES = .39). No consistent effect of teacher condition was found at posttreatment; however, at follow-up, children who received ETS fared significantly better. Conclusions: This study shows that a school-based CBT program is beneficial for difficult-to-reach children with disruptive behavior: The completion rate was remarkably high, ESs (mean ES = .31) matched those of previous studies with targeted intervention, and effects were maintained or had increased at follow-up.
    Journal of Consulting and Clinical Psychology 07/2013; 81(6). DOI:10.1037/a0033577 · 4.85 Impact Factor
    • "Treatment designs such as those comparing CBT with psychological placebo conditions controlling for the non-specific aspects of CBT (e.g. Hudson et al., 2009; Last et al., 1998; Silverman et al., 1999) are needed for a fuller understanding of cognitive mediation of CBT outcome (Hudson, 2005). While the design of the current study allowed for a test of the temporal precedence of the mediator, a better test of temporal precedence would be facilitated via a design in which there are more frequent assessment points, including assessment during the active phase of treatment. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Background: Cognitive-behavioural therapy (CBT) has proven to be effective for anxiety-based school refusal, but it is still unknown how CBT for school refusal works, or through which mechanisms. Aims: Innovative statistical approaches for analyzing small uncontrolled samples were used to investigate the role of self-efficacy in mediating CBT outcomes for anxiety-based school refusal. Method: Participants were 19 adolescents (12 to 17 years) who completed a manual-based cognitive-behavioural treatment. Primary outcomes (school attendance; school-related fear; anxiety) and secondary outcomes (depression; internalizing problems) were assessed at post-treatment and 2-month follow-up. Results: Post-treatment increases in school attendance and decreases in fear about attending school the next day were found to be mediated by self-efficacy. Mediating effects were not observed at 2-month follow-up. Conclusions: These findings provide partial support for the role of self-efficacy in mediating the outcome of CBT for school refusal. They contribute to a small body of literature suggesting that cognitive change enhances CBT outcomes for young people with internalizing problems. Regarding methodology, the product of coefficient test appears to be a valuable way to study mediation in outcome studies involving small samples.
    Behavioural and Cognitive Psychotherapy 09/2012; 41(5):1-16. DOI:10.1017/S1352465812000756 · 1.69 Impact Factor
Show more