Cognitive-behavioral therapy for children with anxiety disorders : evaluation of a brief program reflecting usual practice duration

Four anxiety disordered 8-11 year-old children (aged 8-11 years) and their parents participated in a shortened version of an efficacious cognitive-behavioral program for anxiety in children (Kendall et al., 1992; Ronan & Deane, 1998), designed to reflect therapy duration found in usual clinical practice. A modified multiple-baseline design was used that reflected clinic setting pragmatics (Hayes, 1981; Kazdin, 2003) while continuing to reflect an allegiance to systematic evaluation. For ongoing evaluation, weekly measures of the child’s trait anxiety and coping ability were obtained from the child and parents. In addition, a battery of measures was used to evaluate outcomes following treatment and at two follow-up intervals. Emphasising increased parent involvement, and earlier introduction of exposure sessions, the program was found to lead to marked changes in child functioning. In particular, all children showed improvement on self-report, parent report, and independent clinician’s ratings over the course of treatment. Moreover, scores on relevant indices were all within a non-deviant range following intervention, and all four children no longer qualified for an anxiety diagnosis at post-treatment and at 3- and 12-month follow-up. Findings are discussed in terms of implementation and evaluation in practice settings (e.g., comorbidity, critical components of treatment, use of single case designs). Suggestions for future research include testing the effectiveness of this brief program on a large and diverse sample of children. Additional research is also required to find out to what extent the increased parental involvement of this program enhances the impact of treatment in the larger context of addressing features of the research-practice gap. In light of findings here suggesting the earlier introduction of exposure sessions to be advantageous, another related issue for future research should aim to identify the active ingredients in childhood anxiety programs. Overall, findings provide preliminary support for the effectiveness of a brief cognitive-behavioral program for treating anxiety disorders in children, compatible with some of the needs of service delivery settings.