Hostname: page-component-586b7cd67f-g8jcs Total loading time: 0 Render date: 2024-11-22T19:00:10.807Z Has data issue: false hasContentIssue false
  • English
  • Français

Cognitive-Behavioral Group Therapy for Youths with Anxiety Disorders in the Community: Effectiveness in Low and Middle Income Countries

Published online by Cambridge University Press:  26 February 2013

Maria Augusta Mansur de Souza ,
Giovanni A. Salum ,
Rafaela Behs Jarros ,
Luciano Isolan ,
Roberta Davis ,
Daniela Knijnik ,
Gisele Gus Manfro  and
Elizeth Heldt
Maria Augusta Mansur de Souza*
Affiliation:
Federal University of Rio Grande do Sul (UFRGS), Brazil
Giovanni A. Salum
Affiliation:
Federal University of Rio Grande do Sul (UFRGS), Brazil
Rafaela Behs Jarros
Affiliation:
Federal University of Rio Grande do Sul (UFRGS), Brazil
Luciano Isolan
Affiliation:
Federal University of Rio Grande do Sul (UFRGS), Brazil
Roberta Davis
Affiliation:
Federal University of Rio Grande do Sul (UFRGS), Brazil
Daniela Knijnik
Affiliation:
Federal University of Rio Grande do Sul (UFRGS), Brazil
Gisele Gus Manfro
Affiliation:
Federal University of Rio Grande do Sul (UFRGS), Brazil
Elizeth Heldt
Affiliation:
Federal University of Rio Grande do Sul (UFRGS), Brazil
*
Reprint requests to Maria Mansur de Souza, UFRGS, Lucas de Oliveira, 2776/202 Porto Alegre, Rio Grande do Sul 90460000, Brazil. E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Background: Although cognitive-behavioral therapy (CBT) is established as a first line treatment for anxiety disorders in children and adolescents, there is little evidence about the effectiveness of CBT protocols in cases identified in the community in low and middle income countries (LaMICs). Aims: To evaluate the effectiveness of group CBT protocol for youths with anxiety disorders identified in a community sample in LaMICs. Method: A total of 14 sessions of group CBT for youths and 2 concurrent sessions for parents based on Kendall's Coping Cat program were offered. Participants were selected from a cross-sectional community study; 45 subjects fulfilled inclusion criteria and 28 agreed to participate in the open clinical trial. Treatment effectiveness was evaluated with standard clinical, self- and parent-rated measures of anxiety, depression, externalizing symptoms and quality of life (QoL). Results: Twenty youths completed the protocol. All scales showed an improvement of anxiety and reduction in externalizing symptoms over time, with a moderate to large effect size (d = 0.59 to 2.06; p < .05), but not in depressive symptoms or QoL. Conclusions: Consistent with previous evidence, group CBT is effective in treating anxiety disorders in youths. Results encourage further randomized clinical trials using CBT protocols adapted and developed to be used in LaMICs.

Keywords

Cognitive-behavioral therapyanxiety disordersyouthgroup therapy
Type
Empirically Grounded Clinical Interventions
Information
Behavioural and Cognitive Psychotherapy , Volume 41 , Issue 3 , May 2013 , pp. 255 - 264
Copyright
Copyright © British Association for Behavioural and Cognitive Psychotherapies 2013

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Beesdo, K., Knappe, S. and Pine, D. S. (2009). Anxiety and anxiety disorders in children and adolescents: developmental issues and implications for DSM-V. Psychiatric Clinics of North America, 32, 483–524.Google Scholar
Beidas, R. S., Benjamin, C. L., Puleo, C. M., Edmunds, J. M. and Kendall, P. C. (2010). Flexible applications of the Coping Cat Program for anxious youth. Cognitive and Behavioral Practice, 17, 142–153.Google Scholar
Birmaher, B., Khetarpal, S., Brent, D., Cully, M., Balach, L., Kaufman, J., et al. (1997). The Screen for Child Anxiety Related Emotional Disorders (SCARED): scale construction and psychometric characteristics. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 545–553.CrossRefGoogle ScholarPubMed
Braga, D. T., Manfro, G. G., Niederauer, K. and Cordioli, A. V. (2010). Full remission and relapse of obsessive-compulsive symptoms after cognitive-behavioral group therapy: a two-year follow-up. Revista Brasileira de Psiquiatria, 32, 164–168.Google Scholar
Connolly, S. D., Bernstein, G. A. and Issues, W. G. O. Q. (2007). Practice parameter for the assessment and treatment of children and adolescents with anxiety disorders. Journal of the American Academy of Child and Adolescent Psychiatry, 46, 267–283.CrossRefGoogle ScholarPubMed
Cordioli, A. V., Heldt, E., Braga, D. B., Margis, R., Sousa, M. B., Tonello, J. F., et al. (2003). Cognitive-behavioral group therapy in obsessive-compulsive disorder: a randomized clinical trial. Psychotherapy and Psychosomatics, 72, 211–216.CrossRefGoogle Scholar
Costello, E. J., Egger, H. L. and Angold, A. (2005). The developmental epidemiology of anxiety disorders: phenomenology, prevalence, and comorbidity. Child and Adolescent Psychiatric Clinics of North America, 14, 631–648.Google Scholar
Edwards, T. C., Huebner, C. E., Connell, F. A. and Patrick, D. L. (2002). Adolescent quality of life, Part I: conceptual and measurement model. Journal of Adolescence, 25, 275–286.Google Scholar
Golfeto, J. H. and D'Oliveira, A. B. (2004). Prevalence study of depressive symptomatology and the risk of suicide in school children in Ribeirão Preto evaluated by the Inventory of Child Depression (CDI)]. Revista Brasileira de Psiquiatria, 26, 68–69.Google Scholar
Guy, W. (1976). Clinical Global Impression (CGI). In ECDEU Assessment Manual for Psychopharmacology. US Department of Health and Human Services, Public Health Service, Alcohol Drug Abuse and Mental Health Administration, NIMH Psychopharmacology Research branch. Rockville, MD: National Institute of Mental Health, 218–222.Google Scholar
Heldt, E., Kipper, L., Blaya, C., Salum, G. A., Hirakata, V. N., Otto, M. W., et al. (2011). Predictors of relapse in the second follow-up year post cognitive-behavior therapy for panic disorder. Revista Brasileira de Psiquiatria, 33, 23–29.CrossRefGoogle ScholarPubMed
Heldt, E., Manfro, G. G., Kipper, L., Blaya, C., Maltz, S., Isolan, L., et al. (2003). Treating medication-resistant panic disorder: predictors and outcome of cognitive-behavior therapy in a Brazilian public hospital. Psychotherapy and Psychosomatics, 72, 43–48.Google Scholar
Isolan, L., Salum, G. A., Osowski, A. T., Amaro, E. and Manfro, G. G. (2011). Psychometric properties of the Screen for Child Anxiety Related Emotional Disorders (SCARED) in Brazilian children and adolescents. Journal of Anxiety Disorders, 25, 741–748.CrossRefGoogle ScholarPubMed
James, A., Soler, A. and Weatherall, R. (2007). Cognitive Behavioural Therapy for Anxiety Disorders in Children and Adolescents (Cochrane Review). In The Cochrane Library, Issue 4. New York: Wiley and Sons.Google Scholar
Kaufman, J., Birmaher, B., Brent, D., Rao, U., Flynn, C., Moreci, P., et al. (1997). Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version (K-SADS-PL): initial reliability and validity data. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 980–988.Google Scholar
Kendall, P. C., Brady, E. U. and Verduin, T. L. (2001). Comorbidity in childhood anxiety disorders and treatment outcome. Journal of the American Academy of Child and Adolescent Psychiatry, 40, 787–794.CrossRefGoogle ScholarPubMed
Kendall, P. C., Flannery-Schroeder, E., Panichelli-Mindel, S. M., Southam-Gerow, M., Henin, A. and Warman, M. (1997). Therapy for youths with anxiety disorders: a second randomized clinical trial. Journal of Consulting and Clinical Psychology, 65, 366–380.Google Scholar
Kendall, P. C. and Hedtke, K. A. (2006a). Cognitive-Behavioral Therapy for Anxious Children: therapist manual for group treatment. Coping Cat (3rd ed.). Pennsylvania: Workbook Publishing.Google Scholar
Kendall, P. C. and Hedtke, K. A. (2006b). The Coping Cat Workbook (2nd ed.). Pennsylvania: Workbook Publishing.Google Scholar
Kendall, P. C., Khanna, M. S., Edson, A., Cummings, C. and Harris, M. S. (2011). Computers and psychosocial treatment for child anxiety: recent advances and ongoing efforts. Depression and Anxiety, 28, 58–66.Google Scholar
Kendall, P. C., Safford, S., Flannery-Schroeder, E. and 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.Google Scholar
Kessler, R. C., Berglund, P., Demler, O., Jin, R., Merikangas, K. R. and Walters, E. E. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62, 593–602.Google Scholar
Klein, R. G. (2009). Anxiety disorders. Journal of Child Psychology and Psychiatry, 50, 153–162.Google Scholar
March, J. S. (2011). Looking to the future of research in pediatric anxiety disorders. Depression and Anxiety, 28, 88–98.CrossRefGoogle Scholar
McLean, C. P. and Foa, E. B. (2011). Prolonged exposure therapy for post-traumatic stress disorder: a review of evidence and dissemination. Expert Review of Neurotherapeutics, 11, 1151–1163.Google Scholar
Merikangas, K. R., He, J. P., Burstein, M., Swanson, S. A., Avenevoli, S., Cui, L., et al. (2010). Lifetime prevalence of mental disorders in US adolescents: results from the National Comorbidity Survey Replication-Adolescent Supplement (NCS-A). Journal of the American Academy of Child and Adolescent Psychiatry, 49, 980–989.CrossRefGoogle ScholarPubMed
Patrick, D. L., Edwards, T. C. and Topolski, T. D. (2002). Adolescent quality of life, part II: initial validation of a new instrument. Journal of Adolescence, 25, 287–300.Google Scholar
The Research Units on Pediatric Psychopharmacology Anxiety Study Group (2002). The Pediatric Anxiety Rating Scale (PARS): development and psychometric properties. (2002). Journal of the American Academy of Child and Adolescent Psychiatry, 41, 1061–1069.Google Scholar
Roza, S. J., Hofstra, M. B., Van Der Ende, J. and Verhulst, F. C. (2003). Stable prediction of mood and anxiety disorders based on behavioral and emotional problems in childhood: a 14-year follow-up during childhood, adolescence, and young adulthood. American Journal of Psychiatry, 160, 2116–2121.Google Scholar
Rynn, M., Puliafico, A., Heleniak, C., Rikhi, P., Ghalib, K. and Vidair, H. (2011). Advances in pharmacotherapy for pediatric anxiety disorders. Depression and Anxiety, 28, 76–87.Google Scholar
Salum, G. A., Isolan, L. R., Bosa, V. L., Tocchetto, A. G., Teche, S. P., Schuch, I., et al. (2011). The multidimensional evaluation and treatment of anxiety in children and adolescents: rationale, design, methods and preliminary findings. Revista Brasileira de Psiquiatria, 33, 181–195.Google Scholar
Serra-Pinheiro, M. A., Mattos, P. and Angélica, R. M. (2008). Inattention, hyperactivity, and oppositional-defiant symptoms in Brazilian adolescents: gender prevalence and agreement between teachers and parents in a non-English speaking population. Journal of Attention Disorders, 12, 135–140.Google Scholar
Shaffer, D., Gould, M. S., Brasic, J., Ambrosini, P., Fisher, P., Bird, H., et al. (1983). A children's global assessment scale (CGAS). Archives of General Psychiatry, 40, 1228–1231.Google Scholar
Walkup, J. T., Albano, A. M., Piacentini, J., Birmaher, B., Compton, S. N., Sherrill, J. T., et al. (2008). Cognitive behavioral therapy, sertraline, or a combination in childhood anxiety. The New England Journal of Medicine, 359, 2753–2766.Google Scholar
Submit a response

Comments

No Comments have been published for this article.