Computer-Assisted Cognitive Behavioral Therapy for Child Anxiety: Results of a Randomized Clinical Trial

Article (PDF Available)inJournal of Consulting and Clinical Psychology 78(5):737-45 · October 2010with270 Reads
DOI: 10.1037/a0019739 · Source: PubMed
This study examined the feasibility, acceptability, and effects of Camp Cope-A-Lot (CCAL), a computer-assisted cognitive behavioral therapy (CBT) for anxiety in youth. Children (49; 33 males) ages 7-13 (M = 10.1 ± 1.6; 83.7% Caucasian, 14.2% African American, 2% Hispanic) with a principal anxiety disorder were randomly assigned to (a) CCAL, (b) individual CBT (ICBT), or (c) a computer-assisted education, support, and attention (CESA) condition. All therapists were from the community (school or counseling psychologists, clinical psychologist) or were PsyD or PhD trainees with no experience or training in CBT for child anxiety. Independent diagnostic interviews and self-report measures were completed at pre- and posttreatment and 3-month follow-up. At posttreatment, ICBT or CCAL children showed significantly better gains than CESA children; 70%, 81%, and 19%, respectively, no longer met criteria for their principal anxiety diagnosis. Gains were maintained at follow-up, with no significant differences between ICBT and CCAL. Parents and children rated all treatments acceptable, with CCAL and ICBT children rating higher satisfaction than CESA children. Findings support the feasibility, acceptability and beneficial effects of CCAL for anxious youth. Discussion considers the potential of computer-assisted treatments in the dissemination of empirically supported treatments.

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Available from: Muniya Khanna
    • "SD = 3.79), both out of maximum total scores of 32. The caregiver mean compares favorably to the mean of 26.75 found in a treatment trial using CBT with depressed adolescents exposed to interpersonal trauma (Shirk, DePrince, Crisostomo, & Labus, 2014) and 26.80 found in another treatment trial using CBT to treat children with anxiety disorders (Khanna & Kendall, 2010). Therapist satisfaction with treatment was also high. "
    [Show abstract] [Hide abstract] ABSTRACT: To address implementation challenges faced by some evidence-based youth psychotherapies, we developed an efficient transdiagnostic approach-a potential "first course" in evidence-based treatment (EBP)-guided by five empirically supported principles of therapeutic change. An open trial of the resulting FIRST protocol was conducted in community clinics. Following a 2-day training, staff practitioners treated 24 clinically referred youths ages 7-15, 50% male, 87% White and 13% Latino, all with the Schedule for Affective Disorders and Schizophrenia for School-Age Children Diagnostic and Statistical Manual of Mental Disorders (4th ed.) anxiety, depressive, or conduct-related disorders, and averaging 2.21 disorders. We evaluated the protocol's (a) feasibility for use in everyday clinical practice (examining therapy process, client engagement, and therapist adherence and competence in using the protocol), (b) acceptability (examining therapeutic alliance and treatment satisfaction by youths, caregivers, and therapists), and (c) potential for clinical benefit (examining treatment outcomes across multiple measures and time points). FIRST scored well on measures of feasibility, acceptability to clients and clinicians, and clinical outcomes, matching or exceeding the corresponding scores in most benchmarking comparisons. Observational coding of sessions showed high levels of protocol adherence (86.6%) and good therapist competence in the evidence-based skills. Weekly assessments throughout treatment showed effect sizes for clinical improvement ranging from .41 to 2.66 on weekly total problems and problems deemed "most important" by caregivers and youths. The FIRST protocol showed evidence of feasibility, acceptability, and clinical benefit when used by practitioners with referred youths treated in community clinics. The findings suggest sufficient potential to justify a full randomized controlled trial of FIRST.
    Full-text · Article · Jul 2016
    • "Results from pilot studies on a computer-based treatment for pediatric anxiety (e.g., Cool Teens) suggest potential barriers to youth participation are finding time to complete the modules, being bored, not wanting to practice therapy tasks, having to disclose too much personal information, not having enough therapist support, not understanding the tasks, and losing interest (Cunningham et al., 2006; Cunningham and Wuthrich, 2008; Wuthrich et al., 2012 ). In a small open pilot trial of a computer-assisted program for children with anxiety, Camp-Cope-A- Lot (CCAL; Khanna and Kendall, 2010), two of six children thought the program was boring, two lost interest coming to sessions, and two children endorsed that they thought the program was too long. Encouragingly, in another open trial with 6 children receiving CCAL, all of the children felt supported by the therapist and other potential barriers (e.g., homework time, technical problems, understanding tasks and information, treatment relevance, time for practicing) were infrequently endorsed (Salloum et al., 2015). "
    [Show abstract] [Hide abstract] ABSTRACT: Anxiety disorders are the most common psychiatric disorders among children in the United States; yet many children do not receive treatment due to barriers to treatment access and participation. This study examined common barriers to treatment access and participation among anxious children who participated in computer-assisted cognitive behavioral therapy. Differences in barriers reported by treatment completers/non-completers were examined, as was the association with sociodemographic characteristics, anxiety severity, and impairment. The impact of barriers on treatment response was assessed, as well as the relationship with treatment expectancy and satisfaction.
    Article · Feb 2016
    • "These treatment elements are based on the premise that repeated exposure to feared situations results in a desensitization to them, reducing anxiety and avoidant behaviours, and improving functioning. The structured and sequential nature of CBT translates well to computer-based delivery via the Web [19] and initial research has demonstrated feasibility for a variety of CBT interventions for treating anxiety202122. We developed an Internet-based, CBT treatment program (named Breathe) for anxious adolescents with mild to moderate distress and impairment. "
    [Show abstract] [Hide abstract] ABSTRACT: Background: Use of the Internet to deliver cognitive behavioural therapy, a frontline treatment for anxiety disorders, is emerging as an option to increase access to treatment among adolescents with anxiety disorders. This study examined the usability of the Internet-based component of Breathe, a CBT program designed for adolescents with mild to moderate anxiety and impairments. Methods: A mixed-method usability testing design with semi-structured interviews, task completion, and survey by trained usability moderators was undertaken with two interactive cycles to determine the usability (ease of use, efficiency, errors, and user satisfaction) of the user interface and content areas of the program. Purposeful sampling was used to recruit mental health clinicians with expertise in treating adolescent anxiety disorders and young people aged 15 to 24 years involved. Testing involved using Web-conferencing software that allowed remote participation through personal computers. Two testing cycles involved participants completing structured 'think aloud' and 'cognitive walkthrough' tasks within the program. At the end of each cycle participants completed a 15-item global usability evaluation survey and were asked a series of open-ended questions. Descriptive and simple content analyses were used to identify and score usability issues for frequency and severity. Results: Five clinicians and four young people (all < 20 years of age) participated. Most participants described their computer skills as 'good' (60 % clinicians, 50 % young people), and attitudes toward Internet-based health care ranged from negative (75 % young people) to positive (60 % clinicians, 25 % young people). Scores from the global usability evaluation after both testing cycles ranged from 3.5 to 5 out of 5 in strong agreement/support of the program in terms of user performance indicators (i.e., learnability, efficiency and number of errors) and user satisfaction. Participants were able to complete all critical tasks with minimal errors. Errors and issues identified during testing were predominantly around enhancements to the visual design and navigational support. Opinions across usability elements did not differ between young people and clinician participants. Conclusions: A multi-method remote usability approach provided the opportunity to improve the technical interface, therapeutic messaging and user experience of an Internet-based treatment program for adolescent anxiety disorders.
    Full-text · Article · Dec 2015
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