Building Confidence Program

Guide to Effective Programs
for Children and Youth

BUILDING CONFIDENCE PROGRAM

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). Children were assessed at pre-test, mid-treatment, and post-test to assess whether behavioral improvement had been made. Results based on an independent evaluation and parent reports, but not child reports, indicated that though both groups showed marked improvements, those in the Building Confidence program showed greater benefits.

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 that emphasizes exposure and rewards, combined with parent training. FCBT uses a family focused approach and treats both the child as well as 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, each with three separate meetings for each session. The initial 15 to 30 minutes of the meeting consists of an individual meeting with just the child. The parent-training session 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, instead of hinder, 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 treatment package for the Building Confidence program costs $335 and includes a user’s guide, the parent manual, Continuing Education General Knowledge Course, treatment manual, and the therapist’s reference copy.

EVALUATION(S) 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. American Academy of Child and Adolescent Psychiatry, 45, 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 between 6 and 13 years old. Children were referred by local school psychologists, principals, and/or a medical center-based child anxiety clinic. The child 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). The child was not allowed to be in psychotherapy, 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 application and practice. The FCBT condition was using the Building Confidence protocol. The main difference between the groups is that parents were trained and incorporated into the FCBT protocol.

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.

SOURCES FOR MORE INFORMATION

References:

Website: http://www.socio.com/ced09.php

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

Program information last updated 9/27/11.