I.

Clinical Question

Is individual cognitive behavior therapy a better method than group family-focused cognitive behavior therapy in the treatment of anxiety among children?

II. Citation de Groot, J., Cobham, V., Leong, J., & McDermott, B. (2007). Individual versus group family-focused cognitive-behaviour therapy for childhood anxiety: pilot randomized controlled trial. Australian & New Zealand Journal of Psychiatry, 41(12), 990-997. doi:10.1080/000486707016894 III. Study Characteristics Patients included

Participants were 29 children (10 girls and 19 boys), ranging in age from 7 to12 years, with a principal diagnosis of an anxiety disorder. The mean age of children was 8.86 years. The ICBT condition consisted of 14 children (five girls and nine boys) with a mean age of 8.79 years (SD1.37), while the GCBT condition consisted of 15 children (five girls and 10 boys) with a mean age of 8.93 years (SD1.67). Interventions compared The interventions done were using individual cognitive behavior therapy (CBT) and group family-focused cognitive behavior therapy (CBT) in the treatment of social anxiety among children. Some children were treated using individual CBT. The study used questionnaire measures, treatment programme, and structured diagnostic interview in assessing the childrens anxiety and to attain the desired outcome as possible. Outcomes monitored The parents completed the Strengths and Difficulties Questionnaire Extended Version (SDQ) [34,35] and a Family Demographic Form that provided parental education and occupation details. The SDQ is a parent-report measure of psychopathology in children and adolescents aged 3 16 years. The scale consists of 25 items on a 3 point scale and generates five scale scores (Emotional Symptoms, Conduct Problems, Inattention/Hyperactivity, Peer Problems and Prosocial Behaviour) and a Total Difficulties Score. The Total Difficulties score has adequate internal reliability (a 0.76) [36] and test retest reliability (r0.85) [35]. The

extended version assesses whether the parent thinks the child has a problem, and if so, the perceived impact on the child and burden on the family (rated on a 4 point scale). The SDQ has also been increasingly used in treatment outcome research with this population [31]. In the present study the SDQ Emotional Symptoms Scale (SDQ-Em) was used as a parent measure of child anxiety. It has been shown to have adequate internal reliability (a0.73) and good test retest reliability r0.62 [37] Does the study focus problem in clinical practice? No, because since the child has social anxiety, he is then afraid to go out of their house. The study becomes applicable only in the clinical setting if the child is being brought to the clinic, assessing the manifestations that the child has been having and planning the interventions to be done. IV. Methodology/Design Methodology used Twenty-nine clinically anxious children aged between 7 and 12 years were randomly allocated to either individual cognitive behaviour therapy (ICBT) or group cognitive behaviour therapy (GCBT). A questionnaire package containing details of which condition the family had been allocated to and parent and child self-report measures was then mailed to the family. Parents were asked to return the measures either at their first session or by post prior to the commencement of therapy. Families in the ICBT and GCBT conditions were assessed at preand post-treatment, 3 month and 6 month follow-up. Assessment consisted of completion of the parent and self-report measures outlined in the following section. Design The study used Statistical Analysis as their design in constructing this study. The child and parent questionnaire data were analyzed in two stages, first from pre- to post-treatment time-points to investigate immediate treatment effects; and then across post-treatment, 3 month and 6 month follow up to investigate the maintenance of any effects over the followup period. Setting The study was conducted by professionals at the University of Queensland, Australia in germane to their Child and Adolescent Anxiety Project. Data Sources

The study used primary data sources since the response of the child to the treatment is the focus of this research study. There were data that came from the patients in the assessment part, since the doctor needs to know the manifestations that the child has been having, including its behavior and cognitive thinking.

Subject selection

Inclusion Criteria The inclusion criterion was an anxiety diagnosis of clinical significance. Children with comorbid depression were included, given the high level of overlap between these disorders, providing that their primary diagnosis was an anxiety disorder. Three children met criteria for a comorbid diagnosis of dysthymia, but at mild levels of severity. Children were excluded from the study if they had significant medical problems; severe learning difficulties; if they were under reatment elsewhere (including medication), or if they met diagnostic criteria for a clinically significant non-anxiety diagnosis. Exclusion Criteria Children were excluded from the study if they had significant medical problems; severe learning difficulties; if they were under treatment elsewhere (including medication), or if they met diagnostic criteria for a clinically significant non-anxiety diagnosis. Has the original study has been replicated? Yes, there has been a continuous study in providing better ways to assess and provide effective treatment for children with social anxiety. V. Results of the Study VI. Authors Conclusions/Recommendations Anxiety is a significant problem among children and adolescents, and the majority who experience this problem do not receive professional help [38]. The present pilot study compared the effectiveness of delivering treatment in a group and individual format. The study results demonstrate that children who received the family-focused CBT intervention in either group or individual format reported significant and marked improvement over time. No difference was detected between treatment conditions in the percent of children who recovered from their anxiety disorder. The effects were of clinical significance as indicated by a reduction in the percentage of children in the treatment conditions who had a clinical diagnosis of anxiety at post-treatment assessment. In children who did retain a

diagnosis at post-treatment assessment, the severity was significantly reduced from before to after treatment. Such improvements were evident for children across group and individual. VII. Applicability The applicability of this study in the treatment of social anxiety among children provides an option to render the best intervention that the client may receive. This study can be used in the field of psychiatric nursing, as nurses would properly gain knowledge and skills in dealing with children who have social anxiety. VIII. Reviewers Commentary All of us experience anxiety in different ways. Some of us can cope up to a a stressful situation, while others do not. Anxiety is also categorized in levels, depending on the sympathetic vasomotor response of the body to the stimulus. Indeed, there is a healthy type of anxiety, which is mild anxiety. This type of anxiety increases learning capabilities of a person, increases awareness and focus, and increases attentiveness. Social anxiety is a usual problem if a person has not successfully completed the first stage of psychosocial task; trust vs mistrust, This unmet task signifies that the child develops a social anxiety towards the people in his environment. This child uses defense mechanisms such as isolation as their coping mechanism to an event. They usually stay at home, not going out since they are thinking that there is something bad that is going to happen outside. The development of treatments for this disorder resolves the impending problem of the patient, and it also instill hope and chance for the children to see how beautiful the world is, and how happy it is to mingle with the people they love and people that surround them. I just hoped that the provision of treatments with social anxiety will have continuous progression as year passes by to help the children resolve the conflict that they have been suffering from since the time they developed fear and anxiety to the world.

Weighted events