Evidence Based InterventionEDPS 674Leanne, Megan, Amy

Coping Cat is a cognitive behavioral treatment that assists school-age children in:

(1) Recognizing anxious feelings and physical reactions to anxiety

(2) Clarifying cognition in anxiety-provoking situations (i.e., unrealistic expectations)

(3) Developing a plan to help cope with the situation (i.e., determining what coping actions might be effective)

(4) Evaluating performance and administering self-reinforcement as appropriate.

Introduction: What is Coping Cat?

Target Area: AnxietyAge range: 8-13Authors: Philip C. Kendall & Kristina HedtkePublisher: Workbook Publishing, Inc.Featured Products

◦ Interactive computer programs◦ Workbooks for participant youth◦ Treatment manuals for therapists

Training requirements: none have been set16 sessions, 50 minutes eachTranslated into Chinese, Hebrew, Japanese, Norwegian, Romanian, Hungarian, and Spanish

Overview

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)

About Coping Cat

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 anxietyIs the primary diagnosis(excluding psychosis and IQ < 80)

Treatment Guidelines

Used to help determine if Anxiety is the primary concern

1. Initial phone screen2. Structured parent and child interview3. Treatment decision

Client Screening

Anxiety conceptualized as tripartite construct

behavioural cognitive

Perceptions worries physical symptoms avoidance reinforcement

Overview of Theoretical Basis

psychological

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

Overview of Theoretical Basis

◦ 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.

F.E.A.R. Plan

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

Coping Cat

SEGMENT 11. Building rapport2. F step: Identifying feelings3. Identify somatic responses4. Parent session5. Introduce relaxation training6. E step: Recognizing anxious self-talk7. A step: Introduce cognitive strategies8. R step: Introduce self-evaluation

Building the FEAR plan

Session 3 Demonstration

Understanding Somatic Responses

Therapist Client Interaction

Beginning of Session: Scaredy Cat vs. Coping Cat

How Do My Family Members Show That They’re Scared?

Activity

?

?

?

How Does My Body React?

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?

1) He ran to school earlier that morning.2) It’s a hot day outside.3) He’s nervous about speaking in front of the class.

Questions About How our Body Reacts

First Step for Coping with Anxiety

S.T.i.C Task for Session 3

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

Exposure and Practice

Session 12Demonstration

Moderate Anxiety

Activity: Medium Situation

F.E.A.R Role Play

Rating Scale

Additional Components

Youth Workbook

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

Computer Program

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

The C.A.T Project

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

Parent Involvement

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

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

Review of Research Basis

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

Review of Research Basis: Family

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

Review of Research Basis: Group

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

Review of Research: Autism

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

Flexibility within Fidelity

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

Areas for Change

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

Summary

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)

Remember…

EDPSY 674 Class

Amy, Megan & LeanneFebruary 28th, 2013

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?

Discussion

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.

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.

References