Program

Aug 27, 2014

OVERVIEW

Coping Cats is a program designed to reduce anxiety symptoms in children currently suffering from an anxiety disorder. Results from experimental evaluations indicate that children who participate in Coping Cats are significantly less likely to have a diagnosable anxiety disorder than children assigned to waitlist control groups. Additionally, compared with children assigned to waitlist control groups, children who participate in Coping Cats have significantly fewer anxiety and depressive symptoms. Results of experimental evaluations have also documented sustained impacts of Coping Cats at one-year follow-up assessments. In contrast, results from an experimental evaluation that compared the outcomes of children who participated in Coping Cats with children who received other mental health services suggest that Coping Cats impact children’s mental health (e.g., presence of a diagnosable anxiety disorder, anxiety and internalizing symptoms) is similar to that of other types of mental health services.

 

DESCRIPTION OF PROGRAM

Target population:  Children and adolescents ages 9 to 13 suffering from anxiety disorders.

The Coping Cats program is an outpatient-program that uses a cognitive behavioral therapy approach.  It assists children suffering from anxiety disorders by teaching children how to (1) recognize anxious feelings and physical reactions; (2) clarify cognitions in anxiety-provoking situations; (3) develop plans to help cope with these situations; and (4) evaluate their performance and administer self-reinforcement as appropriate.  Therapists use behavioral training techniques such as real-life situation modeling, role-playing, relaxation training, and contingent reinforcement.  Therapists also assign homework tasks to reinforce the skills learned in the sessions.

Coping Cats consists of 16 sessions. The first eight are training sessions that introduce, practice, and reinforce the basic concepts of the treatment.  The remaining sessions allow children to further practice the new skills in both imaginary and real-life situations.

The estimated cost of implementing the Coping Cats program is $45.95 per participant.  This cost includes the child’s workbook ($26.95) and the therapist’s implementation manual ($19).  Two optional videos are also available for purchase.  The “Managing Anxiety in Youth: The Coping Cats Video” provides a general introduction for practitioners new to the program, and “The Coping Cat Therapist: Session-by-Session Guide” illustrates the entire treatment sequence in detail using real sessions. Both videos are priced at $50.

 

EVALUATION(S) OF PROGRAM

Kendall, P.C. (1994). Treating anxiety disorders in children:  Results of a randomized clinical trial. Journal of Consulting and Clinical Psychology, 62, 100-110.

Kendall, P.C. & Southam-Gerow, M. (1996). Long-term follow up of a cognitive-behavioral therapy for anxiety-disordered youth. Journal of Consulting and Clinical Psychology, 64(4), 724-730.

Evaluated population:  A total of 47 children between the ages of 9 and 13 with anxiety disorders served as the sample for this study.  Of the 47 participants, 30 were diagnosed with over-anxious disorder, eight with separation anxiety disorder, and nine with avoidant disorder.  Approximately 60 percent of the sample was male, and 76 percent was White/Caucasian.

Approach:  Children were randomly assigned to either participate in the Coping Cats program or an eight-week wait-list control group. Children in the treatment group received an average of 17 therapy sessions, each 50-60 minutes in length. Therapists used the Coping Cats program to provide session-by-session content information as well as content-related therapeutic tasks.  Participants were also asked to complete content-related homework in between sessions. Data were collected before children started Coping Cats (pretest), following the completion of treatment (posttest), and one-year following treatment (follow-up). Outcome variables collected in the study include anxiety and depression symptoms.

Results:  Results indicated that children in the treatment group had significantly lower levels of self-reported and parent-reported depression and anxiety at posttest than children in the control group. However, therapist reports of children’s anxiety at posttest did not differ between the treatment and control groups. Given the wait-list control design, by the one-year follow-up children in the control group had participated in Coping Cats. Therefore, treatment and control comparisons cannot be made. Nevertheless, at the one-year follow-up assessment, the positive impacts of Coping Cats were maintained for the 36 children available to participate in the follow-up study.

Kendall, P.C., Flannery-Schroeder, E., Panichelli-Mindel, S.M., Southam-Gerow, M., Henin, A. & Warman, M. (1997). Therapy for youths with anxiety disorders: A second randomized clinical trial. Journal of Consulting and Clinical Psychology, 65(3), 366-380.

Kendall, P.C., Flannery-Schroeder, E., Safford, S., Webb, A. (2004). Clinical anxiety treatment: Outcomes in adolescence and impact on substance use and depression at 7.4-year follow-up. Journal of Consulting and Clinical Psychology, 72(2), 276-287.

Evaluated population:  A total of 94 children between the ages of 9 and 13 with anxiety disorders served as the sample for this study.  Of the 94 participants, 55 were diagnosed with over-anxious disorder, 22 with separation anxiety disorder, and 17 with avoidant disorder.  Approximately 62 percent of the full sample was male and 85 percent was White/Caucasian.

Approach:  Parents and children participated in interviews and questionnaires to gather baseline anxiety levels.  Children also participated in behavioral observations.  After intake, children in the sample were randomly assigned to either the 16-week cognitive-behavioral therapy condition, which used treatment materials from the Coping Cat program, or the eight-week wait-list control condition.

Children in the treatment group received an average of 18 60-minute therapy sessions.  Therapists used the Coping Cat treatment manual and the Working with Potential Difficulties guide, for cases of comorbidity and non-compliance, to provide session-by-session content information as well as content-related therapeutic tasks.  Participants were also asked to complete tasks between sessions to reinforce and generalize the skills.

Children were assessed on anxiety, depression and fears using the several self-report measures.  Parents reported children’s anxiety and behaviors and their own depression and anxiety. Data were collected at baseline (pretest), following the eight-week treatment (posttest), one-year after treatment (follow-up), and seven and a half years following treatment (long-term follow-up).

Results:  Results from the experimental evaluation indicate that children who participated in Coping Cats had significantly fewer depression and anxiety symptoms than children in the control group at posttest.  Furthermore, a significantly greater proportion of children in the Coping Cats group no longer had a diagnosable anxiety disorder than children in the control group.

Given the wait-list control design, children in the control group had participated in Coping Cats by the follow-up data collections. Thus, longer-term treatment and control comparisons cannot be made. Nevertheless, at both follow-up assessments, the positive impacts of Coping Cats were maintained for the children who agreed to participate in the follow-up studies (86 children participated in the one-year follow-up, and 85 children participated in the seven and a half year follow-up).

Flannery-Schroeder, E.C. & Kendall, P.C. (2000). Group and individual cognitive-behavioral treatments for youth with anxiety disorders: A randomized clinical trial. Cognitive Therapy and Research, 24(3), 251-278.

Flannery-Schroeder, E., Choudhury, M.S. & Kendall, P.C. (2005). Group and individual cognitive-behavioral treatments for youth with anxiety disorders: 1-Year follow-up. Cognitive Therapy and Research, 29(2), 253-259.

Evaluated population:  A total of 37 children between the ages of 8 and 14 with anxiety disorders served as the sample for this study.  Of the 37 participants, 21 were diagnosed with generalized anxiety disorder, 11 with separation anxiety disorder, and 5 with social phobia.

Approach:  Parents and children completed measures on site.  After receiving an anxiety diagnosis, children were randomly assigned to the waitlist control group, individual therapy (ICBT) or group therapy (GCBT) groups.  Participants assigned to GCBT were randomly assigned in blocks of four.  Children assigned to waitlist group were randomly assigned to ICBT or GCBT following a 9-week wait.

Children in the treatment group received cognitive-behavioral treatment in either group or individual format.  Treatment consisted of 18 weeks of 50-60-minute therapy sessions for the individual format and 18 weeks of 90-minute therapy sessions for the group format.  Therapists used the Coping Cats treatment manual to provide session-by-session content information.  Participants were also asked to complete tasks between sessions to aid in learning the coping skills presented.  All participants were assessed again after treatment (posttest). Also, in a non-experimental follow-up, all participants were assessed again three months following treatment (follow-up) to assess maintanence.  After receiving the treatment, participants were assessed for changes in levels of internalizing symptoms.  Researchers also assessed control group participants at the end of the nine-week waiting period.

Results:  Intent-to-treat analyses were used (pre-treatment scores for subjects not available for the posttest). At the end of treatment, significant changes were found in diagnosis in that, 73 percent of ICBT participants and 50 percent GCBT participants no longer met the criteria for the primary anxiety diagnosis, whereas only 8 percent of those in the control group no longer met criteria.  Parents reported significant differences in coping in treatment group children at posttest, but nonsignifcant changes in the wait list condition.  At the three-month follow-up assessments, the positive impacts for children in the treatment group were maintained.

A total of 30, or 81 percent of the original sample completed the 1-year follow up. Results found both formats, ICBT and GCBT, showed continued improvement in anxiety levels. A greater percentage of ICBT youths than GCBT youth were free of their principal diagnosis.  Child-reported state anxiety was significantly lower among treatment children. Levels were at the pre-treatment level in this 1-year follow up.  Child reported stable anxiety reflected maintenance of significant improvements.  Parent reports demonstrated no significant differences between post and 1-year follow up.  Teacher reports show no treatment effects differences between post and 1-year follow up on internalizing behavior.

Southam-Gerow, M.A., Weisz, J.R., Chu, B.C., McLeod, B.D., Gordis, E.B., Connor-Smith, J.K. (2010). Does cognitive behavioral therapy for youth anxiety outperform usual care in community clinics? An initial effectiveness test. Journal of the American Academy of Child & Adolescent Psychiatry, 49(10), 1043-1052.

Evaluated Population: A total of 48 children with a primary diagnosis of a generalized anxiety disorder (12.5 percent), separation anxiety disorder (37.5 percent), social phobia (27.1 percent), or specific phobia (22.9 percent) participated in the study. On average, children were 10.9 years of age at baseline, and the majority of children were female (56.2 percent), and White/Caucasian (38.5 percent), followed by Latino/Hispanic (33.3 percent), Black/African American (15.4 percent), and multi-racial/other (12.8 percent).

Approach: Children were randomly assigned to participate in the Coping Cats treatment condition (N=24), or a control group (N=24) that received care as usual within a community mental health setting. Data were collected before the start of therapy (pretest), and after the completion of therapy (posttest). Intent to treat (ITT) analyses were conducted, as six children assigned to the treatment condition (25 percent), and five children assigned to the control condition (21 percent) failed to complete the posttest assessment. Outcome variables assessed in the evaluation include presence of a diagnosable anxiety disorder (assessed through a structured clinical interview), anxiety symptoms (child and parent surveys), internalizing symptoms (parent survey), and children’s use of services (interview).

Results: Results of the experimental evaluation indicate that there were no significant differences in the proportion of the children who no longer met the criteria for their primary disorder, or the amount of anxiety and internalizing symptoms experienced by the children. However, children in the control group were significantly more likely to be enrolled in other mental health services (e.g., school counseling, or a second therapist) concurrent with treatment than children in the Coping Cats group.

SOURCES FOR MORE INFORMATION

Implementation information may be obtained from:

Workbook Publishing, Inc.

P.O. Box 67

Ardmore, PA 19003

Phone: (610) 896-9797, Fax: (610) 896-1955

E-mail:  info@workbookpublishing.com

Website(s):

http://www.workbookpublishing.com

http://www.childanxiety.org

References

Kendall, P.C. (1994). Treating anxiety disorders in children:  Results of a randomized clinical trial. Journal of Consulting and Clinical Psychology, 62, 100-110.

Kendall, P.C. & Southam-Gerow, M. (1996). Long-term follow up of a cognitive-behavioral therapy for anxiety-disordered youth. Journal of Consulting and Clinical Psychology, 64(4), 724-730.

Kendall, P.C., Flannery-Schroeder, E., Panichelli-Mindel, S.M., Southam-Gerow, M., Henin, A. & Warman, M. (1997). Therapy for youths with anxiety disorders: A second randomized clinical trial. Journal of Consulting and Clinical Psychology, 65(3), 366-380.

Flannery-Schroeder, E. & Kendall, P.C. (2000). Group and individual cognitive-behavioral therapy for youth with anxiety disorders: A randomized clinical trial. Cognitive Therapy and Research, 24(3), 251-278.

Kendall, P.C., Flannery-Schroeder, E., Safford, S., Webb, A. (2004). Clinical anxiety treatment: Outcomes in adolescence and impact on substance use and depression at 7.4-year follow-up. Journal of Consulting and Clinical Psychology, 72(2), 276-287.

Flannery-Schroeder, E., Choudhury, M.S. & Kendall, P.C. (2005). Group and individual cognitive-behavioral treatments for youth with anxiety disorders: 1-Year follow-up. Cognitive Therapy and Research, 29(2), 253-259.

Southam-Gerow, M.A., Weisz, J.R., Chu, B.C., McLeod, B.D., Gordis, E.B., Connor-Smith, J.K. (2010). Does cognitive behavioral therapy for youth anxiety outperform usual care in community clinics? An initial effectiveness test. Journal of the American Academy of Child & Adolescent Psychiatry, 49(10), 1043-1052.

KEYWORDS: Children, Adolescents, Males and Females (Co-ed), Clinic/Provider-based, Cost, Manual, Counseling/Therapy, Anxiety Disorders/Symptoms, Depression/Mood Disorders

Program information last updated on 8/27/14

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