Evidence Based Intervention EDPS 674 Leanne, Megan, Amy

1. Evidence Based Intervention EDPS 674 Leanne, Megan, Amy

2. Introduction: What is Coping Cat? Coping Cat is a cognitive behavioral treatment that assists school-age children in: • Recognizing anxious feelings and physical reactions to anxiety • Clarifying cognition in anxiety-provoking situations (i.e., unrealistic expectations) • Developing a plan to help cope with the situation (i.e., determining what coping actions might be effective) • Evaluating performance and administering self-reinforcement as appropriate.

3. Overview Target Area: Anxiety Age range: 8-13 Authors: Philip C. Kendall & Kristina Hedtke Publisher: Workbook Publishing, Inc. Featured Products • Interactive computer programs • Workbooks for participant youth • Treatment manuals for therapists Training requirements: none have been set 16 sessions, 50 minutes each Translated into Chinese, Hebrew, Japanese, Norwegian, Romanian, Hungarian, and Spanish

4. About Coping Cat Featured Products and Costs: Ages 8-13 • The “Coping Cat” workbook ($24.00) • Cognitive-behavioral therapy for anxious children: therapist manual, 2nd ed. ($24.00) • Cognitive-behavioral therapy for anxious children: therapist manual for group treatment ($24.00) • Cognitive-behavioral family therapy for anxious children: therapist manual, 2nd ed. ($24.00)

5. Treatment Guidelines Developed for child and adolescent populations with a principle diagnosis of: • Separation Anxiety Disorder (SAD) • Generalized Anxiety Disorder (GAD) • Social Phobia (SP) • Other anxiety related problems Comorbid conditions may be present if anxiety Is the primary diagnosis (excluding psychosis and IQ < 80)

6. Client Screening Used to help determine if Anxiety is the primary concern 1. Initial phone screen 2. Structured parent and child interview 3. Treatment decision

7. Overview of Theoretical Basis • Anxiety conceptualized as tripartite construct behavioural cognitive • Perceptions worries physical symptoms avoidance reinforcement psychological

8. Overview of Theoretical Basis 6 Components of Coping Cat • 1. Psycho-education • 2. Somatic management techniques • 3. Cognitive Restructuring • 4. Problem Solving • 5. Exposure • 6. Relapse Prevention

9. F.E.A.R. Plan • Major component of Coping Cat Program • Building the F.E.A.R plan has both exposure and practice tasks Feeling frightened? Expecting bad things? Attitudes and Actions. Results and Rewards.

10. Coping Cat Overview of sessions • 16 sessions • Organized into two segments Segment 1: Building the FEAR plan Segment 2: Exposure and Practice • Scaredy Cat becomes Coping Cat

11. Building the FEAR plan SEGMENT 1 1. Building rapport 2. Fstep: Identifying feelings 3. Identify somatic responses 4. Parent session 5. Introduce relaxation training 6. E step: Recognizing anxious self-talk 7. A step: Introduce cognitive strategies 8. R step: Introduce self-evaluation

12. Session 3 Demonstration Understanding Somatic Responses Therapist Client Interaction

13. Beginning of Session: Scaredy Cat vs. Coping Cat

14. Activity • How Do My Family Members Show That They’re Scared?

15. How Does My Body React?

16. Questions About How our Body Reacts Terry is about to give a book report in front of his class. He notices that he feels sweaty. Why might he feel this way? • He ran to school earlier that morning. • It’s a hot day outside. • He’s nervous about speaking in front of the class.

17. First Step for Coping with Anxiety

18. S.T.i.C Task for Session 3

19. Exposure and Practice SEGMENT 2 • 9. Parent session • 10. Practice FEAR plan low anxiety (imagine) • 11. Low anxiety (in vivo) • 12. Moderate anxiety (imagine) • 13. Moderate anxiety (in vivo) • 14. High anxiety (imagine)- plan commercial • 15. High anxiety (in vivo)- plan commercial • 16. Final Practice; Review and Summarize; Commercial; Closure of therapeutic relationship; Award Certificate

20. Session 12Demonstration Moderate Anxiety

21. Activity: Medium Situation

22. F.E.A.R Role Play

23. Rating Scale

24. Additional Components

25. Youth Workbook

26. Computer Program • 12 sessions • Cartoon guide (“Charlie”) • *Ages 7 to 12 • Relaxation training • Exposure tasks and role-play • Identification of anxiety symptoms and related thoughts • Built-in reward system • Self-check system

27. The C.A.T Project • Ages 13-17 • “The C.A.T. Project” Manual • “C.A.T. Project” Workbook • Developed as an extension of Coping Cat • 16 sessions using workbook format • Follows similar format • Focus on adolescent-specific concerns • Focus on feelings, somatic symptoms, self-talk, relaxation techniques, problem solving, exposure and practice

28. Parent Involvement • Coping Cat program has a parent companion book • Can have different supporting roles • Consultants • Collaborators • Co-clients • Help to ensure child’s participation and dedication to the program • Addressing behaviours that help to develop or maintain anxiety in their children • Family based Coping Cat program

29. Review of Research Basis • Randomized Clinical Trials • Kendall (1994) • 47 children, ages 9-13 diagnosed with principal anxiety: overanxious disorder (OAD) or avoidant disorder (AD) (GAD, SP, SAD) • “children who received the treatment evidenced a significant positive change from pre- to posttreatment on self-report, parent report, and behavioural observation measures” (p.53) • 64% no longer met diagnostic criteria for their principal diagnosis at posttreatment • Maintained at 1-year follow up • Kendall and Southam-Gerow (1996) • 36 of the 47 children re-assessed • Treatment produced gains maintained at 3.35 year follow-up

30. Review of Research Basis • ... Randomized Clinical Trials • Kendall, Flannery-Schroeder, Panichelli-Mindel, Southam-Gerow, Henin, & Warman (1997) • 94 children, ages 9-13 years • Outcomes supported the efficacy of Coping Cat for treating childhood anxiety • 50% of patients did not meet criteria for principal anxiety disorder at posttreatment; for the remaining 50% there were significant reductions on severity scores • Maintained at one year follow up • Kendall, Safford, Flannery-Schroeder, & Webb (2004) • 90% showed maintenance of gains at 7.4 year follow up

31. Review of Research Basis: Family • Randomized Clinical Trial • Kendall, Hudson, Gosch, Flannery-Schroeder, & Suveg (2008). • 161 youths ages 7-13 and their parents • Child-focused Coping Cat treatment (ICBT) • Family-based Coping Cat treatment (FCBT) • Family-based education/support/attention (FESA) • FCBT and ICBT superior • ICBT * on teacher reports • FCBT * when both parents had anxiety • Maintained at 1 year follow up

32. Review of Research Basis: Group • Randomized Clinical Trial • Flannery-Schroeder & Kendall (2000) • Compared group treatment, individual treatment, and a wait-list control • 37 children, ages 8-14 with principal anxiety disorder • 73% individual, 50% group, 8% wait-list did not meet criteria at posttreatment • Only children receiving individual treatment showed significant improvements on self-report measures • Treatment gains maintained at 3 month follow up

33. Review of Research: Autism • Viecili (2011). • Pilot study • 18 children with ASD • Ages 8-12 • 12 weekly sessions, 1.5 hours in length • Significant decreases in anxiety • 50% demonstrated change in anxiety behaviors

34. Flexibility within Fidelity • Criticisms of manual-based treatments • Prearranged • Rigid approach • Specific procedures • Precludes individuality • Finding middle ground • Using the manual as a guide • Flexible applications • “The model/strategy drives the treatment, not specific sentences or exact techniques” (Kendall, Furr, & Podell, , p. 52). • Adapting treatment goals • Schedule adjustment • Tailoring treatment to individual needs

35. Areas for Change • Length of program (16 sessions) • Updated references (e.g., Raggedy Ann and Andy) • Detailed instructions for S.T.i.C tasks (e.g., story, commercial) • Portfolio for S.T.i.C tasks

36. Summary • Coping Cat is an empirically supported CBT treatment for anxious children and adolescents • Long-term treatment gains • Seeks to educate both children and parents about anxiety (signs and skills) • Can be implemented in both community and school settings • Flexible format -Individual or group/family • Rapport between therapist and child is integral to the efficacy of this program

37. Remember… • With any therapeutic program or intervention, it is important to evaluate and monitor the client’s symptomology. • “Manual-based treatments can and should be adapted flexibly to match the individual client presentation” (Beidas et al., 2010)

38. EDPSY 674 Class Amy, Megan & Leanne February 28th, 2013

39. Discussion Based on our presentation, what do you feel are the positive aspects of using Coping Cat to work with anxious youth? In your opinion, what might be some of the drawbacks?

40. References Beidas, R. S., Benjamin, C. L., Puleo, C. M., Edmunds, J. M., & Kendall, P. C. (2010). Flexible applications of the Coping Cat program for anxious youth. Cognitive and Behavioral Practice, 17, 141-153. 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, 251-278. Kendall, P.C. (1990). Coping Cat workbook. Ardmore, PA: Workbook. 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., Flannery-Schroeder, E., Panichelli-Mindel, S., Southam-Gerow, M., Henin, A., & Warman, M. (1997). Therapy for youth with anxiety disorders: A second randomized clinical trial. Journal of Consulting and Clinical Psychology, 65, 366- 380. Kendall, P.C., Furr, J.M., & Podell, J.L. (2003). Child focused treatment of anxiety. Retrieved February, 2013 from... Kendall, P. C., Gosch, E., Furr, J. M., & Sood, E. (2008, September). Flexibility within fidelity. Journal of the American Academy of Child and Adolescent Psychiatry, 47-9, 987-993. Kendall, P.C., Hudson, J., Gosch, E., Flannery-Schroeder, E., & Suveg, C. (2008). Cognitive-behavioral therapy for anxiety disordered youth: A randomized clinical trial evaluating child and family modalities. Journal of Consulting and Clinical Psychology, 76, 282-297.

41. References Kendall, P.C., Safford, S., Flannery-Schroeder, E., & Webb, A. (2004). Child 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, 276-287. Kendall, P.C. & Southam-Gerow, M. (1996). Long-term follow up of cognitive- behavioral therapy for anxiety-disordered youth. Journal of Consulting and Clinical Psychology, 64, 724-730. Kendall, P. C., Robin, J. A., Hedtke, K. A., Suveg, C., Flannery-Schroeder, E., & Gosch, E. (2005). Considering CBT with anxious youth? Think exposures. Cognitive and Behavioral Practice, 12, 136-150. Khanna, M. S., & Kendall, P. C. (2008). Computer-assisted CBT for child anxiety: The Coping Cat CD-ROM. Cognitive and Behavioral Practice, 15, 159-165. Podell, J. L., Mychailyszyn, M., Edmunds, J., Puleo, C. M., & Kendall, P. C. (2010). The Coping Cat program for anxious youth: The FEAR plan comes to life. Cognitive and Behavioral Practice, 17, 132-141.