Effectiveness of a Cognitive Behavioral Therapy-Based Indicated Prevention Program for Children with Elevated Anxiety Levels: a Randomized Controlled Trial

Abstract

Childhood anxiety is a problem not only because of its negative consequences on the well-being of children but also because of its adverse effects on society and its role in mental disorders later in life. Adequate prevention might be the key in tackling this problem. The effectiveness of Coping Cat, as an indicated CBT-based prevention program in Dutch primary school children, was assessed by means of a randomized controlled trial. In total, 141 children aged 7–13 with elevated levels of anxiety and their mothers were included and randomly assigned to an intervention group and a waiting list control group. After screening, all participants completed baseline, post-intervention, and 3-month follow-up assessments. The results showed that Coping Cat, as an indicated prevention program, reduces children’s self-reported anxiety symptoms, with Cohen’s effect size d of 0.66 at the 3-month follow-up. A moderating effect was found for baseline anxiety level; specifically, children with high levels of baseline anxiety who received the Coping Cat program had lower anxiety levels at follow-up compared to children with high levels of anxiety in the control condition. No moderating effects of gender or age were found. An unexpected decline in anxiety levels from screening to pre-assessment was found in both groups, and this decline was stronger in the experimental group. These promising results warrant the implementation of Coping Cat as an indicated prevention program.

Preventing Childhood Anxiety Disorders: Is an Applied Game as Effective as a Cognitive Behavioral Therapy-Based Program?

“…In trials assessing non-inferiority, it is essential that the effect of the gold standard—in this case CBT—is comparable to previous trials. Accordingly, in the current study, the CBT condition yielded effects in line with a previous indicated prevention trial (van Starrenburg et al 2017 ). Furthermore, efficacy results for MindLight were comparable to those of an initial RCT (Schoneveld et al 2016 ).…”

“…The equivalence margin for improvement in anxiety score was set at 0.16 SCAS points. This difference corresponds to 0.5 SD of the anxiety change score ( M = 0.14, SD = 0.32) at post-test in children allocated to CBT, as found in a previous indicated prevention RCT (van Starrenburg et al 2017 ). Based on 80% power (1 − β) to detect a clinically relevant difference in improvement of 0.16 points on the SCAS ( α = .05, two-sided), 50 children were required in each group.…”

“…The program teaches children both cognitive (i.e., cognitive restructuring) and behavioral techniques (i.e., relaxation training and exposure). In the current study, a shortened eight-session version of the indicated prevention group-based version of van Starrenburg et al ( 2017 ) was used. We shortened the Van Starrenburg et al version of Coping Cat according to the content of the American shortened version of the same program (Beidas et al 2013 ) in which the problem-solving part was reduced.…”

“…We choose MindLight over Dojo , because anxiety symptoms are most prevalent in childhood and MindLight is, in contrast to Dojo , designed for children. Based on previous indicated prevention RCTs with MindLight (Schoneveld et al 2016 ) and CBT (van Starrenburg et al 2017 ), our primary hypothesis was that children with elevated anxiety symptoms in the MindLight condition would show comparable decreases in anxiety symptoms as children in the CBT condition. Further, we aimed to test the effectiveness of the design of the game beyond its impact on anxiety symptoms.…”

Assessing anxiety disorders in children and adolescents

“…Sensitivity to treatment effects: Significant effect for treatment versus wait list control or treatment as usual for SCAS‐C and SCAS‐P (Arendt, Thastum, & Hougaard, ; Cobham, ; Wuthrich et al., ). SCAS‐C (Barrett, Farrell, Ollendick, & Dadds, ); Child but not parent effects (van Starrenburg, Kuijpers, Kleinjan, Hutschemaekers, & Engels, ). Parent but not child effects (Donovan, Cobham, Waters, & Occhipinti, ; Vigerland et al., )…”