Program

Sep 15, 2011

OVERVIEW

Bibliotherapy is an
alternative to traditional therapist-client treatment that focuses on self-help
through the use of printed materials. In the Helping Your Anxious Child
program, parents act as therapists, using written materials to help treat their
child’s anxiety disorder. Through the program, parents help familiarize their
children with techniques for managing and understanding anxiety.

An experimental
evaluation of the program found that following the treatment there was a
significantly greater number of children in the bibliotherapy condition without
an anxiety disorder than those in the waitlist group. However, these numbers
were significantly less than those in the standard group treatment (this
treatment, the Cool Kids Program, is summarized

here). The same pattern also existed in terms of improvement across
time in disorder severity. For parent reports of child anxiety levels and
parent reports of child internalizing and externalizing behavior, children in
bibliotherapy did not differ from those in the waitlist condition, but were
significantly less improved than those in group treatment. No differences were
found between groups for child reports of anxious symptoms or negative
thoughts/beliefs.

Three month
follow-up assessments were conducted for the bibliotherapy and standard group
treatment conditions. The proportion of those in the bibliotherapy treatment
who no longer met the criteria for being diagnosed with an anxiety disorder was
significantly lower than for those in group treatment. Similarly, children in
bibliotherapy improved significantly less than the standard group treatment
condition over time from baseline to follow-up on measures of diagnostic
severity, parent ratings of symptoms of anxiety, and parent reports of
internalizing and externalizing behavior. There were no significant differences
between conditions on measures of children’s reports of symptoms of anxiety and
negative thoughts/beliefs, although scores did significantly change over time.

DESCRIPTION OF
PROGRAM

Target
Population:
Children with anxiety disorders

The bibliotherapy
treatment program consists of having parents of child participants conduct
treatment using self-help materials that have been constructed to mimic
empirically supported child anxiety treatments. Each parent is supplied with a
copy of a regularly available book called “Helping Your Anxious Child: A
Step-by-Step Guide,” which explains strategies for managing anxiety and methods
for helping children become familiar with such techniques. Child participants
also receive workbooks containing worksheets and summaries that are found in the
parent’s copy of the book.

Parents receive
cover letters that explain the components of the program. Each parent is to
work through the treatment with their child at their own pace, but a suggested
timetable is supplied, and assessments are set for three months after the
distribution of the treatment materials. No further contact between
participants and the researchers or therapists is initiated. However, if a
parent does make contact, researchers remind parents of the timeline and
encourage them to keep working through the program. If a parent reports serious
issues with their child’s condition worsening, participants are referred to a
clinical supervisor to determine the most appropriate action to be taken.

Program materials
are available through the Sociometrics website (www.socio.com).
Each treatment package, including all necessary materials, is priced at $315.

EVALUATION(S) OF
PROGRAM

Evaluated
population:
260 Year 1 through 6 (the Australian categorization for
primary/elementary school – ages 6 through 12) children were selected for the
study. To be included, children had to meet the Diagnostic and Statistical
Manual of Mental Disorders, 4th edition
(DSM-IV) criteria for
having an anxiety disorder (as diagnosed by trained clinical psychology graduate
students or qualified clinical psychologists). Principal diagnoses of
participating children included generalized anxiety disorder, social phobia,
separation anxiety disorder, specific phobia, obsessive-compulsive disorder, and
panic disorder.

Approach:
Participants were randomly assigned to either the bibliotherapy treatment
(N=90), standard group treatment (N=90), or a waitlist condition (N=87). The
only significant difference between groups at baseline was that the group
treatment condition had a larger proportion of female participants. For a
description of the standard treatment condition (the Cool Kids Program), see the
link provided above. Children assigned to the waitlist condition were told that
they had been randomly selected to wait for treatment and would be re-assessed
after a 3 month period, at which point the group treatment program would be made
available to them.

To measure the
effectiveness of the bibliotherapy program, data was collected from diagnostic
interviews, and from both child self-report measures and parent reports of their
child’s behavior. These scales covered outcomes such as symptoms of anxiety
(child and parent reports), negative thoughts/beliefs (child), and child
internalizing and externalizing behavior (parent). All measures and diagnostic
interviews were completed at baseline and immediately following the conclusion
of the treatment programs for all three conditions, but only the bibliotherapy
and group treatment conditions were assessed at a three-month follow-up.

Results: A
significant difference was found between conditions in the proportion of
participants dropping out (not returning data at the end of the intervention).
Twenty-nine dropouts were from bibliotherapy, 14 were from group treatment, and
12 were from the waitlist condition. A comparison on psychopathology measures
demonstrated that those who dropped out had significantly higher scores on
several psychopathology measures and significantly greater numbers of multiple
diagnoses of disorders.

Immediately
following the intervention, a significantly greater number of children in the
bibliotherapy condition than those in the waitlist were free of an anxiety
disorder, but significantly less than those in the standard group treatment.
Similarly, across time children in the bibliotherapy condition improved
significantly more than those in the waitlist in the severity of their disorder,
but significantly less than those in group treatment. For parent reports of
child anxiety levels, participants in the bibliotherapy condition did not differ
from those in the waitlist condition, while participants in group treatment were
significantly more improved than those in waitlist. Bibiliotherapy participants
were significantly less improved than those in group treatment. The same
pattern was also shown for parent reports of both child internalizing and
externalizing behavior. No differences were found between groups in terms of
child reports of anxious symptoms or negative thoughts/beliefs.

At the three month
follow-up, the proportion of those in the bibliotherapy treatment who no longer
met the criteria for having an anxiety disorder was significantly lower than for
those in group treatment. There was a significant difference in change across
time between both groups from baseline to follow-up (bibliotherapy improved less
than group treatment), but not from post-treatment to follow-up for diagnostic
severity, parent ratings of symptoms of anxiety, and parent reports of
internalizing and externalizing behavior. For children’s reports of symptoms of
anxiety and negative thoughts/beliefs, scores significantly improved over time,
but there were no significant differences between conditions.

SOURCES FOR MORE
INFORMATION

Website:

http://www.socio.com/ced08.php

References

Rapee, R.M.,
Abbott, M.J., Lyneham, H.J. (2006). Bibliotherapy for children with anxiety
disorders using written materials for parents: A randomized controlled trial. Journal of Consulting and Clinical Psychology, 74(3), 436-444

KEYWORDS:
Children, Adolescents, Elementary, Middle School, Males and Females (Co-ed),
Home-Based, Cost Information is Available, Manual is Available,
Counseling/Therapy, Parent or Family Component, Anxiety Disorders/Symptoms

Program
information last updated 9/15/11

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