Quality of Research
Review Date: October 2006
Documents Reviewed
The documents below were reviewed for Quality of Research. The research point of
contact can provide information regarding the studies reviewed and the availability
of additional materials, including those from more recent studies that may have been conducted.
Study 1Kendall, P. C. (1994). Treating anxiety disorders in children: Results of a randomized clinical trial. Journal of Consulting and Clinical Psychology, 62(1), 100-110. 
Kendall, P. C., & Southam-Gerow, M. A. (1996). Long-term follow-up of a cognitive-behavioral therapy for anxiety-disordered youth. Journal of Consulting and Clinical Psychology, 64(4), 724-730. Study 2Flannery-Schroeder, E., Suveg, C., Safford, S., Kendall, P. C., & Webb, A. (2004). Comorbid externalizing disorders and child anxiety treatment outcomes. Behavior Change, 21(1), 1-12.
Kendall, P. C., Flannery-Schroeder, E., Panichelli-Mindel, S. M., Southam-Gerow, M., Henin, A., & Warman, M. (1997). Therapy for youths with anxiety disorders: A second randomized clinical trial. Journal of Consulting and Clinical Psychology, 65(3), 366-380.
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(2), 276-287. Study 3Flannery-Schroeder, E., Choudbury, M. S., & Kendall, P. C. (2005). Group and individual cognitive-behavioral treatments for youth with anxiety disorders: 1-year follow-up. Cognitive Therapy and Research, 29(2), 253-259.
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(3), 251-278.
Supplementary Materials Kendall, P. C., Chu, B., Gifford, A., Hayes, C., & Nauta, M. (1998). Breathing life into a manual: Flexibility and creativity with manual-based treatments. Cognitive and Behavioral Practice, 5, 177-198.
Kendall, P. C., Robin, J. A., Hedtke, K. A., & Suveg, C. (2005). Considering CBT with anxious youth? Think exposures. Cognitive and Behavioral Practice, 12, 136-148.
Kendall, P. C., & Treadwell, K. R. H. (2007). The role of self-statements as a mediator in treatment for youth with anxiety disorders. Journal of Consulting and Clinical Psychology, 75(3), 380-389.
Treadwell, K. R., & Kendall, P. C. (1996). Self-talk in youth with anxiety disorders: State of mind, content specificity, and treatment outcome. Journal of Consulting and Clinical Psychology, 64(5), 941-950.
Outcomes
| Outcome 1: Anxiety diagnoses/disorders |
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Description of Measures
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Anxiety diagnoses/disorders were determined by the Anxiety Disorder Interview Schedule (ADIS), which was administered to both children and parents. The ADIS instruments are structured interview schedules for the diagnosis of anxiety disorders that allow the assessor to screen out other disorders and are consistent with DSM-III-R criteria. The ADIS-IV-Lifetime was used for long-term follow-up because this measure is psychometrically preferable for young adults.
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Key Findings
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In one study, the number of children receiving the Coping Cat model of CBT who were diagnosed with overanxious disorder or separation anxiety disorder decreased (p < .0001 and p < .01, respectively) from pretreatment to 1 year and 3.5 years posttreatment.
In another study, the anxiety diagnosis was no longer primary for more than 92% of former Coping Cat participants at 7.4 years posttreatment, based on client and parent interviews.
Another evaluation that compared individual and group formats of Coping Cat with a wait-list control condition found that 81% of participants in the individual format no longer met criteria for their primary anxiety disorder at 1-year follow-up. The percentage was slightly lower (77%) for the group format.
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Studies Measuring Outcome
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Study 1, Study 2, Study 3
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Study Designs
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Experimental
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Quality of Research Rating
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3.5
(0.0-4.0 scale)
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| Outcome 2: Anxiety symptoms--child report |
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Description of Measures
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Children's self-reported anxiety symptoms were measured using six instruments: (1) Revised Children's Manifest Anxiety Scales (RCMAS), which measures child's chronic anxiety traits including psychosocial symptoms, worry and oversensitivity, and concentration; (2) State-Trait Anxiety Inventory for Children (STAIC), which measures enduring tendencies to experience anxiety and temporal and situational variations in levels of perceived anxiety; (3) Fear Survey Schedule for Children--Revised (FSSC-R), a 3-point scale that assesses specific fears in children; (4) Coping Questionnaire--Child (CQ-C), designed to assess changes in children's perceived ability to manage specific anxiety provoking situations; (5) Children's Negative Affectivity Self-Statement Questionnaire (NASSQ), which are self-statements that children endorse on a scale representing the frequency with which each thought occurred during the past week; and (6) Social Anxiety Scale for Children--Revised (SASC-R), consisting of 22 statements which children rate on a 5-point scale.
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Key Findings
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Several studies found a significant decrease in child-reported anxiety symptoms in children who received treatment, compared with children in comparison groups (p < .05). The effect was maintained at the long-term follow-up (through 7.4 years). In more than one study, children's coping ability increased significantly from pretreatment to posttreatment (p < .001).
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Studies Measuring Outcome
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Study 1, Study 2, Study 3
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Study Designs
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Experimental
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Quality of Research Rating
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3.7
(0.0-4.0 scale)
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| Outcome 3: Anxiety symptoms--parent report |
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Description of Measures
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Parent-reported anxiety symptoms in their children were assessed using (1) the Child Behavior Checklist (CBCL) which measures an array of behavioral problems and social competencies, provides scores on several factors or behavior problem areas, and indentifies internalizing and externalizing problems; (2) the State-Trait Anxiety Inventory for Children--Modification of Trait Version for Parents (STAIC-A-Trait-P), with which parents rate the child's trait anxiety; and (3) the Coping Questionnaire--Parent (CQ-P) which assesses parents' perception of the child's ability to manage specific anxiety-provoking situations.
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Key Findings
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Several studies found a decrease in parent-reported anxiety symptoms (p < .05). Improvements in anxiety symptoms were maintained through 7.4 years posttreatment.
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Studies Measuring Outcome
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Study 1, Study 2, Study 3
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Study Designs
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Experimental
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Quality of Research Rating
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3.4
(0.0-4.0 scale)
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| Outcome 4: Anxiety symptoms--teacher report |
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Description of Measures
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Teacher-reported anxiety symptoms of their students were assessed using the Child Behavior Checklist--Teacher Report Form (TRF). This measure provided a picture of the child's classroom functioning.
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Key Findings
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In three evaluations of students receiving the intervention, teacher-reported anxiety symptoms decreased from pretreatment to 1 year posttreatment (p < .01).
In one study, 60% of children who received treatment and none of the children in the wait-list comparison group achieved internalizing scores within normative range.
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Studies Measuring Outcome
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Study 1, Study 2, Study 3
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Study Designs
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Experimental
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Quality of Research Rating
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3.3
(0.0-4.0 scale)
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| Outcome 5: Anxiety symptoms--behavioral observation |
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Description of Measures
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Children were observed performing a task on videotape. Observers used codes to record the occurrence of six anxiety-related behaviors during the videotaped task: (1) gratuitous verbalizations (e.g., stating a physical complaint, dislike for a task); (2) gratuitous body movements (e.g., kicking or shaking leg, rocking body); (3) avoiding task (e.g., leaving the room, not talking); (4) absence of eye contact (e.g., not looking at camera); fingers in mouth (e.g., biting fingernails, touching hand to lips); and (5) trembling voice (e.g., giggling within observational intervals, inaudible speech). The occurrence of each code during 10 30-second intervals was scored and reported as a percentage of the observed units.
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Key Findings
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Behavioral observations found that participants in Coping Cat model of CBT had reduced anxiety symptoms (e.g., trembling voice, fingers in mouth, absence of eye contact); in contrast, anxiety symptoms increased in the wait-list group. The difference in total observation scores was significant (p < .02).
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Studies Measuring Outcome
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Study 1, Study 2
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Study Designs
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Experimental
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Quality of Research Rating
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3.3
(0.0-4.0 scale)
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Study Populations
The following populations were identified in the studies reviewed for Quality of
Research.
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Study
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Age
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Gender
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Race/Ethnicity
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Study 1
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6-12 (Childhood)
13-17 (Adolescent)
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52% Male
48% Female
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78% White
22% Black or African American
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Study 2
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6-12 (Childhood)
13-17 (Adolescent)
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63% Male
37% Female
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85% White
5% Black or African American
5% Race/ethnicity unspecified
3% Asian
2% Hispanic or Latino
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Study 3
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6-12 (Childhood)
13-17 (Adolescent)
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51% Male
49% Female
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Data not reported/available
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Quality of Research Ratings by Criteria (0.0-4.0 scale)
External reviewers independently evaluate the Quality of Research for an intervention's
reported results using six criteria:
For more information about these criteria and the meaning of the ratings, see Quality of Research.
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Outcome
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Reliability
of Measures
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Validity
of Measures
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Fidelity
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Missing
Data/Attrition
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Confounding
Variables
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Data
Analysis
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Overall
Rating
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1: Anxiety diagnoses/disorders
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4.0
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3.0
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3.0
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4.0
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3.0
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4.0
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3.5
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2: Anxiety symptoms--child report
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4.0
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3.5
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3.5
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4.0
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3.0
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4.0
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3.7
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3: Anxiety symptoms--parent report
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3.5
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3.0
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3.0
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4.0
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3.0
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4.0
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3.4
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4: Anxiety symptoms--teacher report
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3.0
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3.0
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3.0
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4.0
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3.0
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4.0
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3.3
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5: Anxiety symptoms--behavioral observation
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4.0
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2.0
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3.0
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4.0
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3.0
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4.0
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3.3
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Study Strengths Reliable instruments were used to measure all outcomes. The use of ADIS-IV-L for outcome 1 (decrease in anxiety diagnosis/disorders) was excellent for long-term follow-up. For outcome 5 (decrease in anxiety symptoms reported from behavioral observations), codes used were adapted from another instrument that appears to have face validity. Additional information was provided about fidelity in each successive study, with the third study having a sound mechanism for assessing fidelity. Attrition was moderate, and appropriate techniques were used to deal with missing data. A rigorous design was used for all studies, minimizing the potential for counfounds. Studies used approriate analytical techniques.
Study Weaknesses In one study, both individual and group treatments shared the same essential content and procedure; there was no comparison to an alternative treatment condition. All three studies reviewed were limited to the possibility of nonspecific or alternative explanations to positive change. In addition, there are alternative confounds of awareness of condition status and different timelines for pre-/posttreatment versus delayed treatment (wait-list) groups.
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Readiness for Dissemination
Review Date: October 2006
Materials Reviewed
The materials below were reviewed for Readiness for Dissemination. The implementation
point of contact can provide information regarding implementation of the intervention
and the availability of additional, updated, or new materials.
Kendall, P. C., Choudhury, M., Hudson, J., & Webb, A. (2002). The CAT project manual for the cognitive-behavioral treatment of anxious adolescents. Ardmore, PA: Workbook Publishing.
Kendall, P. C., Choudhury, M., Hudson, J., & Webb, A. (2002). The CAT project workbook for the cognitive behavioral treatment of anxious adolescents. Ardmore, PA: Workbook Publishing.
Kendall, P. C., Chu, B., Gifford, A., Hayes, C., & Nauta, M. (1998). Breathing life into a manual: Flexibility and creativity with manual-based treatments. Cognitive and Behavioral Practice, 5, 177-198.
Kendall, P. C., & Hedtke, K. (2006). Cognitive-behavioral therapy for anxious children: Therapist manual (3rd ed.). Ardmore, PA: Workbook Publishing.
Kendall, P. C., & Hedtke, K. (2006). The Coping CAT workbook (2nd ed.). Ardmore, PA: Workbook Publishing.
Kendall, P. C., Robin, J., Hedtke, K., & Suveg, C. (2005). Considering CBT with anxious youth? Think exposures. Cognitive and Behavioral Practice, 12, 136-148.
Readiness for Dissemination Ratings by Criteria (0.0-4.0 scale)
External reviewers independently evaluate the intervention's Readiness for Dissemination
using three criteria:
- Availability of implementation materials
- Availability of training and support resources
- Availability of quality assurance procedures
For more information about these criteria and the meaning of the ratings, see Readiness for Dissemination.
Implementation
Materials
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Training and Support
Resources
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Quality Assurance
Procedures
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Overall
Rating
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2.5
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1.5
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0.5
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1.5
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Dissemination Strengths The intervention is described in a fair amount of detail with core components listed in the therapist manual. Implementation materials emphasize a strengths-based approach, and each of the workbooks is written to the developmental level of the target audiences. The therapist manual offers clear descriptions of the processes, rationales, and "tips from the trenches" that could inform training and coaching of new therapists. The therapist manual also describes many therapist processes and behaviors and could serve as a guide for developing fidelity and outcome measures.
Dissemination Weaknesses No materials are provided for administrators to assess the contextual requirements to successfully implement the program. Images in both workbooks could do a better job of reflecting racial and cultural differences. Though flexibility is emphasized, no guidance is provided in implementation materials to direct adaptation of the materials for diverse clients. More information and strategies could be provided on engaging families as partners in treatment. Therapist selection factors, methods for training therapists to use the intervention, and the nature and content of coaching and clinical supervision are not discussed. Neither therapist fidelity measures nor client outcome measures is provided.
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Costs
The cost information below was provided by the developer. Although this cost information
may have been updated by the developer since the time of review, it may not reflect
the current costs or availability of items (including newly developed or discontinued
items). The implementation point of contact can provide current information and
discuss implementation requirements.
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Item Description
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Cost
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Required by Developer
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Child's Workbook
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$26.95 each
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Yes
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Therapist's Treatment Manual
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$24 each
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Yes
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Camp Cope-A-Lot: The Coping Cat CD
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$20-$2,000 depending on the number of users and subscription package
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No
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The Coping Cat Video
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$49.95 for VHS, $55.95 for DVD
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No
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The Coping Cat Therapist: Session-by-Session Guide
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$79.95 for VHS, $85.95 for DVD
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No
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CBT4CBT Computer-Based Training To Be a Cognitive-Behavioral Therapist
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$95
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No
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Additional Information The estimated cost to implement Coping Cat is $45.95 per participant.
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Replications
Selected citations are presented below. An asterisk indicates that the document
was reviewed for Quality of Research.
Barrett, P. M. (1998). Evaluation of cognitive-behavioral group treatments for childhood anxiety disorders. Journal of Clinical Child Psychology, 27, 459-468.
Barrett, P. M., Dadds, M. R., & Rapee, R. M. (1996). Family treatment of childhood anxiety: A controlled trial. Journal of Consulting and Clinical Psychology, 64, 333-342.
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 and Clinical Psychology, 69, 135-141.
Bogels, S. M., & Siqueland, L. (2006). Family cognitive behavioral therapy for children and adolescents with clinical anxiety disorders. Journal of the American Academy of Child and Adolescent Psychiatry, 45, 134-141.
Cobham, V. E., Dadds, M. R., & Spence, S. H. (1998). The role of parental anxiety in the treatment of childhood anxiety. Journal of Consulting and Clinical Psychology, 66, 893-905.
* 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(3), 251-278.
* 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., 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., Flannery-Schroeder, E., Panichelli-Mindel, S. M., Southam-Gerow, M., Henin, A., & Warman, M. (1997). Therapy for youths with anxiety disorders: A second randomized clinical trial. Journal of Consulting and Clinical Psychology, 65, 366-380.
Manassis, K., Mendlowitz, S. L., Scapillato, D., Avery, D., Fiksenbaum, L., Freire, M., et al. (2002). Group and individual cognitive-behavioral therapy for childhood anxiety disorders. A randomized trial. Journal of the American Academy of Child and Adolescent Psychiatry, 41, 1423-1430.
Mendlowitz, S. L., Manassis, K., Bradley, S., Scapillato, D., Miezitis, S., & Shaw, B. F. (1999). Cognitive-behavioral group treatments in childhood anxiety disorders: The role of parental involvement. Journal of the American Academy of Child and Adolescent Psychiatry, 38, 1223-1229.
Nauta, M. H., Scholing, A., Emmelkamp, P. M., & Minderaa, R. B. (2003). Cognitive-behavioral therapy for children with anxiety disorders in a clinical setting: No additional effect of a cognitive parent training. Journal of the American Academy of Child and Adolescent Psychiatry, 42, 1270-1278.
Shortt, A. L., Barrett, P. M., & Fox, T. L. (2001). Evaluating the FRIENDS program: A cognitive-behavioral group treatment for anxious children and their parents. Journal of Clinical Child Psychology, 30, 525-535.
Silverman, W. K., Kurtines, W. M., Ginsburg, G. S., Weems, C. F., Lumpkin, P. W., & Carmichael, D. H. (1999). Treating anxiety disorders in children with group cognitive-behavioral therapy: A randomized clinical trial. Journal of Consulting and Clinical Psychology, 67, 995-1003.
Spence, S. H., Donovan, C., & Brechman-Toussaint, M. (2000). The treatment of childhood social phobia: The effectiveness of a social skills training-based, cognitive-behavioral intervention, with and without parental involvement. Journal of Child Psychology and Psychiatry, 41, 713-726.
Wood, J. J., Piacentini, J. C., Southam-Gerow, M., Chu, B. C., & Sigman, M. (2006). Family cognitive behavioral therapy for child anxiety disorders. Journal of the American Academy of Child and Adolescent Psychiatry, 45, 314-321.
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