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Transcript of Action Research
Butler et. al. (2006) wrote a comprehensive literature review titled "The empirical status of cognitive-behavioral therapy: A review of meta-analyses."
The review summarised findings across multiple meta-analyses to find:
Overall effectiveness of CBT
Effectiveness of treating 16 different disorders
Persistance of effects once treatment has ceased
The findings for Generalised Anxiety Disorder (GAD) found CBT to be superior to no-treatment control, nondirective therapy, and pill placebo, and that these effects were maintained for at least 6 months post treatment.
Overall, CBT research on GAD indicates strong long term effects relative to other treatments. Much research on the effectiveness of CBT in the specific area of youth with anxiety.
Compton et. al. (2002) wrote a review in this area entitled "Cognitive-Behavioral Psychotherapy for Anxiety and Depressive Disorders in Children and Adolescents: An Evidence-Based Medicine Review."
The review examined journal articles from 1990-2002, using CBT on children with anxiety or depression aged between 8-18 years old.
For the anxiety component of the review 21 randomly controlled trials were analysed.
The average age of subjects was 9.85 years, with gender and ethnicity well represented.
Follow ups ranging from 3 months to 6 years again found lasting effects of CBT.
This review article provides additional, comprehensive support to the notion that CBT is effective in treating young people with anxiety related issues. Manassis et. al. (2002) conducted an experiment comparing the effectiveness of group and individual CBT titled "Group and individual cognitive-behavioural therapy for childhood anxiety disorders: A randomised trial."
n = 78
Age = 8-12
Anxiety disorder diagnosis
Twelve weeks of CBT
Individual or group sessions
Result: CBT highly effective in both settings.
For a subset of the sample with higher anxiety levels, individual was more effective. 12 Year old Year 6 boy
No previous counsellor involvement
Teacher, parent and self reports indicate some issues with anxiety and depression
Has very few friends
Spends lunctime alone in the library
Has been the victim of bullying.
Had written some suicidal thoughts in his diary
Sad/Happy scale - 2/10
Anxious/Calm scale - 7/10
Responded well to the sessions, actively participating in all of the exercises and discussions.
During one session he indicated he would like to see me without the other group members present.
In this individual session, he discussed his bullying and suicidal thoughts in more detail.
Resilience and dealing with bullying strategies were discussed, as well as some practical interventions.
Quite capable of identifying and replacing unhelpful thoughts, offered good insights into his own thoughts, and generally completed the activities to a high standard. In the final week, demonstrated a significant change in behaviour.
quiet + reserved energetic + outgoing
Why? “because I'm happy”
Could not get a clear answer as to what had changed.
Recent counselling OR Other Factors OR Both?
Sad/Happy scale - 8/10
Anxious/Calm scale - 9/10
Boring/Interesting - 10/10
Unhelpful/Helpful - 9/10 12 Year old Year 6 girl
Previous counsellor involvement in 2003
Recommendation that she repeat Year 1 due to difficulties with spelling, phonics, writing, and gross motor skills.
Diagnosed with ADHD.
WISC-III and Stanford Binet Intelligence Scale - IV: No major deficits.
Teacher completed a CBC during practicum, scoring her in the clinical range for social problems and the borderline clinical range for thought problems.
Sad/Happy scale - 5/10
Anxious/Calm scale - 3/10 Discussed a number of social problems
Making and maintaining friendships
Victim of teasing and bullying
Feels isolated and ostracised from her parents, who are always busy working.
Her parents prevent her from doing many activities that she enjoys. Did not engage as well as the other group members.
Often appeared bored and uninterested.
Revealed a great deal of unhelpful thought processes.
Resistant to change, often attempting to replace an unhelpful thought with another unhelpful thought.
Would often claim that the unhelpful thought was “true”.
This resistance proved difficult to overcome, and I do not feel that I was particularly successful in teaching her CBT strategies to help overcome her problematic thought processes.
Sad/Happy scale - 4/10
Anxious/Calm scale - 4/10
Boring/Interesting - 5/10
Unhelpful/Helpful - 5/10 12 Year old Year 6 boy
Many special needs
Diagnosed with VeloCardio Facial Syndrome
WISC-IV - Moderate intellectual disability (IM)
Has been at his current school for approximately 1 year
Sad/Happy scale - 8/10
Anxious/Calm scale - 7/10 The main problems discussed involved being the victim of bullying, and the broken relationship between his parents.
Was currently doing well in his new school and had found friendship and acceptance as the “class clown”
Enjoyed participating in the sessions, however...
Would often miss the main point of the activities or go off on tangents
Unclear as to how effective the program was for him.
Sad/Happy scale - 8/10
Anxious/Calm scale - 6/10
Boring/Interesting - 5/10
Unhelpful/Helpful - 3/10 PROBLEM! PROBLEM! Sample Size Time Limitations CBT Check It Out! Initially n = 4, finished with n = 3 due to one student dropping out
Too small of a number to draw any conclusions from the data.
Increasing the sample size would increase the amount of data that could be collected, and allow for stronger conclusions to be drawn.
In order to get through all of the material in the limited time available, a number of modifications had to be made.
Sessions run twice per week
Homework activities done in session "n" <-- too small! I gained experience in working with various CBT techniques and concepts, such as challenging unhelpful thoughts and replacing them with helpful thoughts, connecting thoughts, feelings and behaviours, and more.
I now feel more confident in working with these CBT concepts, and will certainly try to incorporate them into my counselling in the future. I gained experience in working within the structure of the Check It Out! program
I found that the exercises and activities in the program were useful in stimulating the students to talk, in a natural, unforced manner.
The group setting allows for extremely efficient use of time.
7 sessions with 3 students would require 21 sessions if I had seen them all individually.
As school counsellors are often pressed for time, group therapy, where appropriate, is a worthwhile option worth considering.
If the opportunity arises, I would certainly consider working with the Check It Out program again in the future. Justification Group Sessions Difference in ability levels between students caused some problems.
Additional individual sessions to supplement the program would have been ideal.
The small nature of this research prevents any strong conclusions from being drawn.
With such a small sample size, and a lack of experimental controls, this study cannot add to the wealth of CBT research that already exists on the topic of youth anxiety.
Instead, this research has implications for myself as a prospective counsellor..... References
Barrett, P. M., Duffy, A. L., Dadds, M. R. & Rapee, R. M. (2001). Cognitive-behavioral treatment of anxiety disorders in children: Long-term (6-year) follow-up. Journal of Consulting & Clinical Psychology, 69(1), 135-141.
Butler, A. C., Chapman, J. E., Forman, E. M., & Beck, A. T. (2006). The empirical status of cognitive-behavioral therapy: A review of meta-analyses. Clinical Psychology Review, 26, 17-31.
Compton, S. N., March, J. S., Brent, D., Albano, A. M., Weersing, V. R., & Curry, J. (2004). Cognitive-Behavioral Psychotherapy for Anxiety and Depressive Disorders in Children and Adolescents: An Evidence-Based Medicine Review. Journal of the American Academy of Child and Adolescent Psychology, 43(8), 930-959.
Graham, P. (2005). Jack Tizard Lecture: Cognitive Behaviour Therapies for Children: Passing Fashion or Here to Stay? Child and Adolescent Mental Health, 10(2), 57-62.
Kasunic, V., Noonan, K. & Leung, P. (2003). Check It Out! :Checking Out” How You Feel, Think, and Act. Sydney South West Area Health Service.
Kendall, P. (1994). Treatment of anxiety disorders in children: A randomized control trial. Journal of Consulting and Clinical Psychology, 62, 100–110.
Kerfoot, M., Harrington, R., Harrington, V., Rogers J., & Verduyn, C. (2004). A step too far: Randomized control trial of cognitive-behaviour therapy delivered by social workers to depressed adolescents. European Child and Adolescent Psychiatry, 13, 92–99.
King, N. J., Heyne, D., & Ollendick, T. H. (2005). Cognitive Behaviour Treatments for Anxiety and Phobic Disorders in Children and Adolescents: A Review. Behavioral Disorders, 30(3), 241-257.
Manassis, K., Mendlowitz, S., Scapillato, D., Avery, D., Fiksenbaum, L., Freire, M., Monga, S., & Owens, M. (2002). Group and individual cognitive-behavioural therapy for childhood anxiety disorders: A randomised trial. Journal of the American Academy of Child and Adolescent Psychiatry, 41, 1423–1430.
Shawe-Taylor, M. & Rigby, J. (1999). Cognitive behaviour therapy: its evolution and basic principles. The Journal of the Royal Society for the Promotion of Health, 199(4), 244-246. Questions? Program Data Collection “Check It Out!” Is an eight week, group based program that utilises CBT principles to assist children in identifying, managing and changing their thoughts, feelings and behaviours.
Group based approach was chosen so as to maximise the number of sessions I could spend with each of the students, in the limited amount of time I had.
The program is founded on CBT principles and aims to teach the skills of;
recognition and management of feelings and their associated bodily sensations
identification of tense and relaxed states
the relationship between thoughts, feelings and behaviours
the difference between helpful and unhelpful thoughts
replacing unhelpful with helpful thoughts
identification of personal strengths. Simple Likert Scales were filled out prior to the commencement of the first session, and after the completion of the final session for comparison.
In addition to this, I gave the students an evaluative feedback form.
This "quantitative" data was designed to supplement my own observations.