Coping Cat CD Study: Therapist/Coach Training

1. Coping Cat CD Study:Therapist/Coach Training Temple University, CAADC July 19, 2007

2. Meeting Agenda • Introductions • Consent forms, assessment, and randomization • Study overview/Preview of Camp Cope-A-Lot (CCAL) • Study procedures • ESA and CCAL treatment implementation • Subject recruitment • Schedule weekly supervision calls (Group A) • Schedule weekly supervision calls (Group B) • Coping Cat treatment implementation

3. Introductions • Developers, supervisors • Philip C. Kendall, Ph.D., ABPP,Temple University • pkendall@temple.edu • Muniya Khanna, Ph.D. University of Pennsylvania • muniya.khanna@gmail.com; 215-746-5704 • Research coordinator • Michelle Wilson, Temple University • michelle.wilson20@gmail.com;215-204-3795 • Research assistant • Katherine Andriole, Villanova University • katherine.andriole@villanova.edu • Rinad Beidas, Temple University

4. Background & Rationale • Why develop a computer-assisted CBT for child anxiety? • Potential benefits of computer-assisted programs • Reduced cost • Increased consistency of care • Increased patient access • Dissemination of empirically supported treatments (Newman, 2000; McCrone et al. 2004; Wright et al., 2005)

5. Bridging Science and Practice • If developed, tested, and refined, this program may be an efficient and effective way to disseminate standardized care and evidence-based CBT for anxiety in youth across multiple facilities. • We are excited about the potential impact on the field of therapy outcome research that this study offers, and we hope that it facilitates bridging the gap between science and practice. • This study is funded by the NIH/NIMH.

6. Introducing: Camp Cope-A-Lot • Children (7 -12yrs) with anxiety • Evidence-based • Computer-assisted treatment • Target Audience • Schools • Community Mental Health Centers • Private Practices • Medical Centers • Training Clinics • Social Service Agencies

7. Preview of CCAL

8. Camp Map

9. Camp Map

12. Our Cast Charlie Mike & Sandy

13. Cast cont’d. Joanie

14. Cast cont’d. Vijay’s Family

15. The Development Process

16. Study 1 Design • CCAL vs. ICBT vs. ESA • N=60 children and adolescents ages 7-12 with principle GAD, SAD, or SP, or other anxiety related problem • Patients will be seen at the volunteer therapists’ site (some space will be available at TU/CAADC – contact Michelle to reserve). • Patient recruitment will be conducted by volunteer therapists as well as our research staff. • Referrals from participating sites will be accepted • All assessments (e.g., pre- and post-treatment) will be conducted by our research staff.

17. Therapist/Coach Guidelines • You will be asked to see up to 4 patients, 12 weeks each, for 35-50 minute sessions. • You will be randomly assigned to subjects and treatment condition. • Treatment will be conducted between September 2007 – January 2008. • All will participate in study training in treatment implementation and weekly phone supervision with Dr. Kendall and developers. • All will be offered training in CBT for child anxiety from Dr. Kendall and developers.

18. Therapist responsibilities – All conditions • Assist in patient recruitment. • Once assigned, contact patient to schedule appointments (schedule 12 weekly meetings). • Give weekly measures. • Conduct (and audiotape) therapy sessions. • Write progress notes. • Participate in weekly supervision. • Inform Michelle of date of session 12.

19. Subject Flow

20. Components of CCAL • 12 “Levels” • 6 Stand-alone • Introduction • Affect recognition/Identify somatic reactions • Relaxation • Cognitive Restructuring • Problem Solving • Self-evaluation and reward • 6 “Coach Assisted” • Graded exposure • Certification • Self-checks & Homework • Reward

21. CCAL Session Structure • Levels 1 - 6 (approximate times): 10 min. Meet/greet child & guardian. Child completes weekly measures (CDI, MASC). Prepare child to begin. 30 min. Child independently works on CCAL program. 10 min. Logout/answer questions. Confirm next appointment. • Levels 7 – 12 (approximate times): 10 min. Meet/greet child & guardian. Child completes weekly measures (CDI, MASC). Prepare child to begin. 10 min. Child independently works on CCAL program. 20 min. Plan and conduct totem pole challenges 10 min. User spends 10 min in GameTime. Logout/answer questions. Confirm next appointment. • Parent Meetings during Levels 3 and 7 (while child is working independently on CCAL).

22. FEAR Plan Feeling Frightened? Expecting bad things to happen? Actions and attitudes that can help. Results and rewards.

23. Building a hierarchy Sample hierarchy: 8 Sleeping at best friend’s house 7 Sleepover with friend at home 6 Sleeping over at grandmom’s 5 Sleeping alone with nightlight 4 Sleeping alone with nightlight, with mom waiting until asleep 3 Calling a new friend to go to movies 2 Talking to someone new in the cafeteria 1 Saying hi to someone new • The child and therapist record different situations which seem to be particularly troublesome for the child. • List fears in order of difficulty (e.g., categorizing fears into “easy,” “medium,” and “challenging”) • Be as specific as possible regarding the situations. For example, vague language is not preferred (e.g., “going to school”). Instead, enter specific situations such as “taking a math test at school” or “eating in the cafeteria.” • It needn’t be perfect: the information will be reviewed and elaborated on weekly basis during the second half of the treatment.

24. Exposure tasks • The FEAR steps are practiced in situations in which the child feels anxious or worried. Practicing these steps in situations that provoke genuine anxiety allows the child to see that he can cope. • The practice is carried out in a gradual way. • The child will experience some anxiety when practicing his skills, but this is to be expected and is OK. The more he practices facing these situations the less anxious he will feel. • The aim of the treatment is not to remove the child’s anxiety all together but to reduce it and to be able to manage it. • The FEAR steps need to be practiced repeatedly. The practice is done both in and out of session. • Depending on the exposure task, the child may need to stay in the situation for a certain duration of time. If he gets out of the situation too quickly, then he hasn’t experienced that he can cope and the next time he enters the situation he will feel the same or even more anxiety.

25. Parent Meetings • Session 3 • gather information and provide treatment overview • Session 7 • provide information about tx, prepare parents for second half of treatment, address any concerns

26. Education, Support & Attention • Session 1 • Describe goals of treatment • Build rapport • Begin discussion about fear & anxiety • Session 2 • Review goals of treatment • Build rapport • Begin discussion about feelings

27. Education, Support & Attention cont’d. • Session 3 Part I (25 min) • Begin discussion about somatic symptoms of anxiety • Discuss the verbal expression of anxiety • Session 3 Part II (25 min) • Parent Meeting: • Review goals of treatment • Review symptoms, adress questions

28. Education, Support & Attention cont’d. • Session 4 • Discuss situations in which child experiences anxiety • Explain survival value of fear • Session 5 • Discuss difference between fear, anxiety, phobia • Session 6 • Describe cognitive theory of emotions

29. Education, Support & Attention cont’d. • Session 7 Part I (25 min) • Describe learning theory of emotions • Session 7 Part II (25 min) • Parent Meeting • Review symptoms • Answer questions • Session 8 • Describe biological theory of emotions

30. Education, Support & Attention cont’d. • Session 9 • Review main concepts from sessions 1-8 • Session 10 & 11 • Discuss child’s experience of anxiety, incorporating concepts learned • Session 12 • Review • Commercial

31. You will receive… • Camp Cope-A-Lot CD Rom • Coach’s manual • Go-to-Gadget (one per case) • ESA manual, video game CD • ESA child notebook • Weekly assessment measures Website to access study documents is pending

32. Supervision Calls • Group A/CCCD therapist conference call: Fridays 2pm (1 hour)