Effectiveness of a cognitive-behavioral therapy (CBT) manualized program for clinically anxious children: study protocol of a randomized controlled trial

<p>Abstract</p> <p>Background</p> <p>In the Netherlands, the prevalence of anxiety disorders is 20%; and children with anxiety are at increased risk for psychopathology throughout adulthood. Recently, a revised version of a cognitive behavioral therapy manualized program called 'Thinking + Doing = Daring' (TDD) was developed for children between 8 and 12 years old with an anxiety disorder. The main aim of this project is to conduct a Randomized Controlled Trial (RCT) to evaluate the effectiveness of TDD.</p> <p>Methods/Design</p> <p>The CBT program will be tested with a RCT with 120 clinically anxious children (8-12 years old) referred to one of three mental health care agencies. Children will be randomly assigned to the experimental (<it>N </it>= 60, TDD) or to the control condition (<it>N </it>= 60, treatment as usual). The primary outcome measure will be the child's anxiety symptoms level. Secondary outcome measures will be externalizing (e.g. aggression) and internalizing problems (e.g. depression). Two potential mediators of change will be examined in the current study: therapeutic alliance and parenting. Mother and child in both the experimental and control condition will be surveyed at baseline, post treatment and after 6 and 12 months (follow-up). It is hypothesized that children in the experimental condition will show a stronger decrease in anxiety symptoms compared to children that receive treatment as usual. Moreover, we expect that a strong therapeutic alliance and decreases in parental control and rejection will contribute to treatment success.</p> <p>Discussion</p> <p>Early treatment for anxiety problems has the potential to not only result in anxiety reductions, but also to prevent future problems such as substance abuse and psychopathology throughout adulthood. Our results will be immediately relevant to practice, since we are partnering with 'real world' community agencies. If the CBT program proves more effective than treatment as usual, it could be implemented in community mental health care agencies across the Netherlands and beyond. Moreover, it has the potential to make treatment in these community settings shorter, more efficient and therefore cost-effective. Trial registration: Nederlands Trial Register NTR2967</p

A randomized controlled trial testing the effectiveness of a universal school-based depression prevention program 'Op Volle Kracht' in the Netherlands

Contains fulltext : 102521.pdf (publisher's version ) (Open Access)Background: The incidence of depressive symptoms increases during adolescence, from 10.0% to 24.5% at age 11 to 15, respectively. Experiencing elevated levels of depressive symptoms increases the risk of a depressive disorder in adulthood. A universal school-based depression prevention program Op Volle Kracht (OVK) was developed, based on the Penn Resiliency Program, aimed at preventing the increase of depressive symptoms during adolescence and enhancing positive development. In this study the effectiveness of OVK will be tested and possible mediators of program effects will be focus of study as well. Method: The effectiveness of OVK will be tested in a randomized controlled trial with two conditions, intervention (OVK) and control condition (care as usual). Schools are randomly assigned to research conditions. OVK will be incorporated in the school curriculum, maximizing program attendance. OVK consists of 16 lessons of 50 min, given by trained psychologists to groups of 11-15 students. OVK contains Cognitive Behavioral Therapy, social skills training, problem solving and decision making. Outcomes are measured at 6, 12, 18 and 24 months follow up, to monitor long term program effects. Primary outcome is level of depressive symptoms, secondary outcomes are: anxiety, hopelessness, cognitive bias, substance use, truancy, life satisfaction, coping, self-efficacy, optimism, happiness, friendship, school performance and school attitude. The questionnaires for students will be administered in the school setting. Parents will complete a questionnaire at baseline only. Discussion: In this paper the study into the effectiveness of the depression prevention program OVK was described. It is expected that OVK will prevent the increase in depressive symptoms during adolescence and enhance positive development in the intervention condition, compared to the control condition. If OVK will be effective, it can be implemented in the school context by which numerous adolescents can be reached.9 p

Effectiveness and underlying mechanisms of a group-based cognitive behavioural therapy-based indicative prevention program for children with elevated anxiety levels

Contains fulltext : 116470.pdf (publisher's version ) (Open Access)Background Anxiety is a problem for many children, particularly because of its negative consequences not only on the wellbeing of the child, but also on society. Adequate prevention and treatment might be the key in tackling this problem. Cognitive behavioural therapy (CBT) has been found effective for treating anxiety disorders. “Coping Cat” is one of the few evidence-based CBT programs designed to treat anxiety symptoms in children. The main aim of this project is to conduct a Randomized Controlled Trial (RCT) to evaluate the effectiveness of a Dutch version of Coping Cat as an indicative group-based prevention program. The second aim is to gain insight into the mechanisms underlying its effectiveness. Methods/design Coping Cat will be tested in Dutch primary school children grades five through eight (ages 7 to 13) with elevated levels of anxiety. This RCT has two conditions: 130 children will be randomly assigned to the experimental (N=65, Coping Cat) and control groups (N=65, no program). All children and their mothers will be asked to complete baseline, post intervention, and 3-month follow-up assessments. In addition, children in both the experimental and control group will be asked to complete 12 weekly questionnaires matched to the treatment sessions. Main outcome measure will be the child’s anxiety symptoms level (SCAS). Four potential mediators will be examined, namely active coping, positive cognitive restructuring, self efficacy and cognitions about ones coping ability (from now on coping cognitions). Discussion It is hypothesized that children in the experimental condition will experience reduced levels of anxiety in comparison with the control group. Further, active coping, positive cognitive restructuring, and coping cognitions are expected to mediate program effectiveness. If Coping Cat proves effective as a prevention program and working mechanisms can be found, this group-based approach might lead to the development of a cost-effective program suitable for prevention purposes that would be easily implemented on a large scale.7 p