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Anxiety Gremlins: mixed methods sequential explanatory evaluation of a CBT group intervention for children

Published online by Cambridge University Press:  06 October 2020

Christopher Meek Open the ORCID record for Christopher Meek [Opens in a new window] ,
Lucy Redstone  and
Nima Moghaddam Open the ORCID record for Nima Moghaddam [Opens in a new window]
Christopher Meek
Affiliation:
Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK
Lucy Redstone
Affiliation:
Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK
Nima Moghaddam*
Affiliation:
School of Psychology, University of Lincoln, Lincoln, UK
*
*Corresponding author. Email: nmoghaddam@lincoln.ac.uk
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Abstract

Although research evidence supports the efficacy of cognitive behavioural therapy (CBT) for anxiety in children, it is important to examine practice-based evidence of effectiveness in typical clinical contexts. This study evaluated a CBT group intervention – ‘Anxiety Gremlins’ – for childhood anxiety. Participants were 36 children (19 boys, 17 girls) aged 8–13, referred for anxiety symptoms at a UK NHS service. The 8-session intervention included six child sessions (2 h) and two parent sessions (1 h). Self-report outcome measures of anxiety symptoms, life functioning and therapeutic relationships were used to measure change pre- and post-intervention. Semi-structured interviews were conducted with group facilitators and analysed through deductive content analysis to identify barriers and facilitators to change. No substantive differences were found between aggregated scores on pre- versus post-intervention outcome measures. Reliable change in anxiety symptoms was identified in 10 children (31%), with five improvers and five deteriorators. Interviews with facilitators identified disruption in group flow, lack of facilitator time to prepare and reflect, and the complexity of clients as hindering factors. Children meeting like-minded peers to share their stories and high engagement in the therapeutic process were helpful factors. Anxiety Gremlins did not demonstrate effectiveness on outcome measures, and this contrasted with clinical opinion. Recommendations were made for the service to revisit the intervention content and the method for recruiting children to the group – as complexity/co-morbidity was linked to poorer outcomes. Future research could explore fidelity to an adapted intervention and include interviews with children and their parents.

Key learning aims

After reading this paper the reader should be able to:

  1. (1) Understand how instances of CBT practice can be robustly evaluated using a mixed-methods approach, including analyses of change at both group and individual levels.

  2. (2) Understand critical considerations when adapting ‘evidence-based’ CBT interventions for routine practice.

  3. (3) Appreciate that aggregative group-level analyses can mask clinically important differences in individual CBT outcomes.

Keywords

anxietyCBTchildrenCoping Catevaluationgroup
Type
Original Research
Information
the Cognitive Behaviour Therapist , Volume 13 , 2020 , e39
Copyright
© British Association for Behavioural and Cognitive Psychotherapies 2020

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References

Further reading

Barkham, M., Hardy, G. E., & Mellor-Clark, J. (2010). Developing and Delivering Practice-Based Evidence: A Guide for the Psychological Therapies. Chichester, UK: Wiley-Blackwell.CrossRefGoogle Scholar
Creswell, J. W., Klassen, A. C., Plano Clark, V. L., & Smith, K. C. (2011). Best practices for mixed methods research in the health sciences. Bethesda: National Institutes of Health, pp. 541–545.Google Scholar
Jacobson, N. S., & Truax, P. (1991). Clinical significance: a statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology, 59, 12–19.CrossRefGoogle ScholarPubMed

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