The feasibility and outcome of clinic plus internet delivery of cognitive-behaviour therapy. Journal of Consulting and Clinical Psychology, 74(3), 614-621
Seventy-two clinically anxious children, aged 7 to 14 years, were randomly allocated to clinic-based, cognitive-behavior therapy, the same treatment partially delivered via the Internet, or a wait-list control (WL). Children in the clinic and clinic-plus-Internet conditions showed significantly greater reductions in anxiety from pre- to posttreatment and were more likely to be free of their anxiety diagnoses, compared with the WL group. Improvements were maintained at 12-month follow-up for both therapy conditions, with minimal difference in outcomes between interventions. The Internet treatment content was highly acceptable to families, with minimal dropout and a high level of therapy compliance.
Available from: Meghan L Marsac
- "Potential malleable targets for the prevention of posttraumatic stress in children that are supported by research evidence include negative appraisals about safety and vulnerability to future harm (Bryant et al., 2007a; Ehlers et al., 2003; Meiser-Stedman, Dalgleish, Glucksman, Yule, & Smith, 2009), the coping strategy of seeking social support (Stallard, Velleman, Langsford, & Baldwin, 2001), and early avoidance behaviors (Ebata & Moos, 1991). Given the strong support for the effectiveness of cognitivebehavioral theory (CBT) interventions to treat mood and anxiety symptoms in children and teens (Cohen & Mannarino, 2008; Kenardy, Spence, & Macleod, 2006; March et al., 2009; O'Kearney, Kang, Christensen, & Griffiths, 2009; Spence et al., 2011), secondary prevention may also benefit from a CBT approach. Coping Coach uses CBT principles, integrating interactive activities and content, to address each malleable intervention target (i.e., appraisals, social support, avoidance behaviors) in the early posttrauma period. "
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ABSTRACT: Medical events including acute illness and injury are among the most common potentially traumatic experiences for children. Despite the scope of the problem, only limited resources are available for prevention of posttraumatic stress symptoms (PTSS) after pediatric medical events. Web-based programs provide a low-cost, accessible means to reach a wide range of families and show promise in related areas of child mental health.
To describe the design of a randomized controlled trial that will evaluate feasibility and estimate preliminary efficacy of Coping Coach, a web-based preventive intervention to prevent or reduce PTSS after acute pediatric medical events.
Seventy children and their parents will be randomly assigned to either an intervention or a waitlist control condition. Inclusion criteria require that children are aged 8-12 years, have experienced a medical event, have access to Internet and telephone, and have sufficient competency in the English language to complete measures and understand the intervention. Participants will complete baseline measures and will then be randomized to the intervention or waitlist control condition. Children in the intervention condition will complete module 1 (Feelings Identification) in the hospital and will be instructed on how to complete modules 2 (Appraisals) and 3 (Avoidance) online. Follow-up assessments will be conducted via telephone at 6, 12, and 18 weeks after the baseline assessment. Following the 12-week assessment, children in the waitlist control condition will receive instructions for completing the intervention.
Primary study outcomes include data on intervention feasibility and outcomes (child appraisals, coping, PTSS and health-related quality of life).
Results will provide data on the feasibility of the implementation of the Coping Coach intervention and study procedures as well as estimations of efficacy to determine sample size for a larger study. Potential strengths and limitations of this design are discussed.
Available from: Clare Bell
- "The telephone administration of the ADIS-P was used to be consistent across groups and reduce the burden on families, particularly since the control children were recruited from a local school and had no reason to attend the University for a face-to-face interview. The telephone administration has good inter-rater reliability (Cobham et al. 1998), a high level of agreement with face-to-face administration (Lyneham and Rapee 2005), and is commonly relied upon for determining the diagnostic status of anxious and non-anxious control groups (e.g., Lyneham and Rapee 2006; Spence et al. 2006). The ADIS-P is a commonly used parent-report interview for the diagnosis of anxiety disorders in children (e.g., Cobham et al. 2010; Hudson et al. 2009; Liberman et al. 2006; Lyneham and Rapee 2006) and possesses sound psychometric properties (Rapee et al. 1994; Silverman et al. 2001). "
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ABSTRACT: This study examined the incidence and correlates of functional gastrointestinal symptoms in children with anxiety disorders. Participants were 6-13 year old children diagnosed with one or more anxiety disorders (n = 54) and non-clinical control children (n = 51). Telephone diagnostic interviews were performed with parents to determine the presence and absence of anxiety disorders in children. Parents completed a questionnaire that elicited information about their child's gastrointestinal symptoms associated with functional gastrointestinal disorders in children, as specified by the paediatric Rome criteria (Caplan et al., Journal of Pediatric Gastroenterology & Nutrition, 41, 296-304, 2005a). Parents and children also completed a symptom severity measure of anxiety. As expected, children with anxiety disorders were significantly more likely to have symptoms of functional gastrointestinal disorders (FGID), compared to children without anxiety disorders. That is, 40.7 % of anxious children had symptoms of a FGID compared to 5.9 % of non-anxious control children. Children with anxiety disorders were significantly more likely to have symptoms of functional constipation, and showed a trend for a higher incidence of irritable bowel syndrome symptoms compared to non-anxious control children. Furthermore, higher anxiety symptom severity was characteristic of anxious children with symptoms of FGID, compared to anxious children without FGID symptoms and non-anxious control children. Also, children with anxiety disorders, regardless of FGID symptoms, were more likely to have a biological family member, particularly a parent or grandparent, with a gastrointestinal problem, compared to non-anxious control children. The high incidence of FGID symptoms in children with anxiety disorders warrants further research on whether gastrointestinal symptoms reduce following psychological treatments for childhood anxiety disorders, such as cognitive behavioural therapy.
Available from: Vanessa Cobham
- "Kazdin suggested that the way forward involves a broad suite of nontraditional models of intervention with a potentially large reach, including brief, minimal, and low-cost treatments. The limited research conducted along these lines to date has focused on bibliotherapy (the focus of the present article) and computer or Internet-based delivery (e.g., Khanna & Kendall, 2010; Spence, Holmes, March, & Lipp, 2006). "
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ABSTRACT: This study compared 3 experimental conditions: wait-list, therapist-supported bibliotherapy, and individual therapy, in the treatment of child anxiety.
Participants were 55 children (25 girls and 30 boys), aged 7 to 14 years diagnosed with an anxiety disorder, and their parents. Families were assigned using a modified random assignment process to 1 of the 3 conditions. The intervention evaluated in the 2 active treatment conditions was a family-focused, cognitive-behavioral program.
At posttreatment, participants in both treatment conditions had improved significantly on both diagnostic and questionnaire outcome measures compared with participants in the wait-list condition, with no differences demonstrated between the treatment conditions. Thus, at posttreatment, 0% of children in the wait-list condition were anxiety diagnosis free, compared with 95% in the therapist-supported bibliotherapy condition and 78.3% in the individual therapy condition. There was no significant difference between diagnostic status at posttreatment between the 2 treatment conditions. Participants assigned to a treatment condition were reassessed at 3-month and 6-month follow-up. Treatment gains were maintained in both conditions across the follow-up period.
In light of the fact that more than 80% of anxiety-disordered children never receive treatment, these data suggest that therapist-supported bibliotherapy represents a cost-effective means of reaching a greater number of anxious children.
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