Program

Building Confidence Program

Jul 14, 2014

OVERVIEW

This study assessed the effectiveness of the Building Confidence program – a form of Cognitive Behavioral Therapy (CBT) that focuses on parental training and involvement.  Forty children with anxiety disorders were randomly assigned to the Building Confidence program, or the control group (CBT without a parental focus). Results indicated that although both groups showed marked improvements, those in the Building Confidence program showed greater benefits. In a one-year follow-up study that assessed the effectiveness of Family Cognitive Behavioral Therapy (FCBT) against Child-focused Cognitive Behavioral Therapy, Wood et al. (2006), found that FCBT was more effective in reducing anxiety in children.

DESCRIPTION OF PROGRAM

Target population: Children and adolescents (age 6 to 13) with anxiety disorders

Drawing from Family Cognitive Behavioral Therapy (FCBT), Building Confidence is a treatment emphasizing skills training, graded fear training, and parent training. FCBT uses a family-focused approach and treats both the child and the parents. Unlike previous FCBT programs, Building Confidence puts an emphasis on changing parental practices and patterns of communication.

The Building Confidence program includes 12 to 16 therapy sessions lasting 60 to 80 minutes, broken into three parts. The initial 15 to 30 minutes of the session consists of an individual meeting with the child. The parent-training meeting takes place during the next 25 to 30 minutes. Finally, the last 10 to 15 minutes are used for a family meeting.

Parents are taught a number of communication techniques to facilitate their child’s mastery of new skills. First, they are instructed to give choices when the child appears indecisive. Next, they are to allow the child to struggle and learn by trial and error, rather than taking over the situation. Third, parents are instructed to label and accept their child’s emotional responses and to resist criticizing them. Finally, parents are to promote the child’s acquisition of novel self-help skills. Parents also use a behavioral rewards system to reinforce target behaviors and a planned ignoring system to reduce anxious behaviors.

The authors developed a treatment manual for the program.

EVALUATION OF PROGRAM

Wood, J. J., Piacentini, J. C., Southam-Gerow, M., Chu, B. C., & Sigman, M. (2006).  Family cognitive behavioral therapy for child anxiety disorders. Journal of the American Academy of Child and Adolescent Psychiatry, 45(3), 314-321. 

Evaluated population: The intent-to-treat sample included 40 children with anxiety disorders living in a major metropolitan area; 38 were in the analysis sample. The children ranged in age from 6 to 13 years old. Children were referred by local school psychologists, principals, and/or a medical center-based child anxiety clinic. The children met the DSM-IV criteria for diagnosis of one of the following anxiety disorders: Seasonal Affective Disorder (SAD), social phobia, or Generalized Anxiety Disorder (GAD). This study screened out children who were in psychotherapy or taking any psychiatric medication at the initial assessment unless it was a stable dose that would not change during the therapy sessions (as sworn in a signed document).

Approach: Children who met the inclusion criteria were randomized by a research assistant to either the Child-focused Cognitive Behavioral Therapy CCBT or FCBT (Building Confidence Program) condition using a computer randomization program.  Children were then randomly assigned to an available therapist. Therapists were required to treat children in both conditions and alternate between them.  In both the CCBT and FCBT conditions, children were given 12 to 16 therapy sessions lasting 60 to 80 minutes each.  In the CCBT condition, the therapist mainly met with the child alone using a procedure guided by an empirically supported CCBT manual.  This program consisted of two phases: skills training and practical application. The FCBT condition used the Building Confidence protocol. The main difference between the groups was that the FCBT protocol trained and incorporated parents.

The child’s anxiety disorder was evaluated using a structured diagnostic interview with the caregiver. The child completed a measure on improvement in anxiety symptoms at pre-treatment, mid-treatment, and post-treatment.

Results: Both groups improved on all measures of anxiety at post-treatment; however, the family treatment approach appeared to have greater benefits.  Analysis of data from an independent evaluator and from parents revealed a greater decline in anxiety severity for children in FCBT than in CCBT. The number of children in the FCBT condition who met the criteria to be considered “completely recovered” or “very much better” was 79 percent, as compared with 26 percent of children in the CCBT condition. However, the improvement based on the children’s own ratings was not statistically significant.

Wood, J. W., McLeod, B. D., Piacentini, J. C., & Sigman, M. (2009). One-year follow-up of family versus child CBT for anxiety disorders: Exploring the roles of child age and parental intrusiveness. Child Psychiatry Human Development, 40, 301-316. doi:10.1007/s10578-009-0127-z

Evaluated Population: This follow-up study included 35 children and their families with anxiety disorders of the original 40 children who had completed the previous treatment of a randomized, controlled trial comparing CCBT and FCBT. Forty children with anxiety disorders were included and 38 of the children and their families completed the intervention and 35 children participated in the one-year follow up of that study. The 35 children studied in the follow-up were between 6 and 10-years-old and 66% were male.

Approach:  Participants received treatment as explained in the above study. One year after the previous study, the participants were tested again using several anxiety measures. These included ADIS-C/P criteria for SAD, GAD, or SP to determine if they meet the criteria for diagnoses in these areas. The Clinical Global Impression – Improvement Scale was used as a criterion for treatment response. The children and parents were also each assessed on the Child Multidimensional Anxiety Scale (MASC) and the Parent MASC respectively. In addition, the parents were also asked to complete a services questionnaire regarding their existing psychotherapy and any medication the child receives as well as a Parent-Child Interaction Questionnaire and a Skills of Daily Living Checklist.

Results: The results of the posttest showed a favorable outcome for both of the treatments. There were no significant impacts on diagnosis. When comparing results on the Clinical Global Impressions – Improvement Scale, researchers found a significant difference between children in the two conditions. Twelve of 18 (66.67%) children in the FCBT condition received a rating of 1 or 2 (completely recovered or very much better) as compared to 3 of 16 (18.75%) in the CCBT condition. Researchers found a significant difference between parents of the two groups when assessed on the Parent MASC but not the Child MASC.

SOURCES FOR MORE INFORMATION

References:

Wood, J. W., McLeod, B. D., Piacentini, J. C., & Sigman, M. (2009). One-year follow-up of family versus child CBT for anxiety disorders: Exploring the roles of child age and parental intrusiveness. Child Psychiatry Human Development, 40, 301-316. doi:10.1007/s10578-009-0127-z

Wood, J. J., Piacentini, J. C., Southam-Gerow, M., Chu, B. C., & Sigman, M. (2006).  Family cognitive behavioral therapy for child anxiety disorders. Journal of the American Academy of Child and Adolescent Psychiatry, 45(3), 314-321.

KEYWORDS: Children, Adolescents, Males and Females, Clinic/Provider-based, Counseling/Therapy, Parent or Family Component, Parent Training/Education, Family Therapy, Anxiety Disorders/Symptoms.

Program information last updated 7/14/14.

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