Transcript What is Coping Cat?

Evidence Based Intervention
EDPS 674
Leanne, 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.
Target Area: Anxiety
Age range: 8-13
Authors: Philip C. Kendall & Kristina Hedtke
Publisher: Workbook Publishing, Inc.
Featured Products
◦ Interactive computer programs
◦ Workbooks for participant youth
◦ Treatment manuals for therapists
Training requirements: none have been set
16 sessions, 50 minutes each
Translated into Chinese, Hebrew, Japanese, Norwegian,
Romanian, Hungarian, and Spanish
Featured Products and Costs: Ages 8-13
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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)
Developed for child and adolescent populations with
a principle diagnosis of:
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Separation Anxiety Disorder (SAD)
Generalized Anxiety Disorder (GAD)
Social Phobia (SP)
Other anxiety related problems
Comorbid conditions may be present if anxiety
Is the primary diagnosis
(excluding psychosis and IQ < 80)
Used to help determine if Anxiety is the
primary concern
1. Initial phone screen
2. Structured parent and child interview
3. Treatment decision
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Anxiety conceptualized as tripartite construct
psychological
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behavioural
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cognitive
Perceptions worries physical symptoms avoidance reinforcement
6 Components of Coping Cat
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Psycho-education
Somatic management techniques
Cognitive Restructuring
Problem Solving
Exposure
Relapse Prevention
◦ 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.
Overview of sessions
 16 sessions
 Organized into two segments
Segment 1: Building the FEAR plan
Segment 2: Exposure and Practice
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Scaredy Cat becomes Coping Cat
Building the FEAR plan
SEGMENT 1
1. Building rapport
2. F step: Identifying feelings
3. Identify somatic responses
4. Parent session
5. Introduce relaxation training
6. E step: Recognizing anxious self-talk
7. A step: Introduce cognitive strategies
8. R step: Introduce self-evaluation
Understanding Somatic Responses
Therapist Client Interaction
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How Do My Family Members Show That
They’re Scared?
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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?
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He ran to school earlier that morning.
It’s a hot day outside.
He’s nervous about speaking in front of the class.
SEGMENT 2
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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
Moderate Anxiety
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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
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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, selftalk, relaxation techniques, problem solving,
exposure and practice
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Coping Cat program has a parent companion
book
Can have different supporting roles
◦ Consultants
◦ Collaborators
◦ Co-clients
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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
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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 followup
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... 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
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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)
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FCBT and ICBT superior
ICBT * on teacher reports
FCBT * when both parents had anxiety
Maintained at 1 year follow up
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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
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Viecili (2011).
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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
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Criticisms of manual-based treatments
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Finding middle ground
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Prearranged
Rigid approach
Specific procedures
Precludes individuality
◦ 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
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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
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Coping Cat is an empirically supported CBT
treatment for anxious children and adolescents
Long-term treatment gains
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Seeks to educate both children and parents about
anxiety (signs and skills)
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Can be implemented in both community and school
settings
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Flexible format -Individual or group/family
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Rapport between therapist and child is integral to
the efficacy of this program
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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)
EDPSY 674 Class
February 28th, 2013
Amy, Megan & Leanne
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?
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, 366380.
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.
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 cognitivebehavioral 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.