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CBT for Autism in School Settings

This study compared cognitive behavioral therapy (CBT) and treatment-as-usual (TAU) in terms of effects on observed social communication-related autism symptom severity during unstructured play time at school for children with autism spectrum disorders (ASD). Thirteen children with ASD (7-11 years old) were randomly assigned to 32 sessions of CBT or community-based psychosocial treatment (TAU) for 16 weeks. The CBT program is based on the memory retrieval competition model and emphasizes the development of perspective-taking through guided behavioral experimentation supplemented with reflective Socratic discussion and supported by parent training and school consultation to promote generalization of social communication and emotion regulation skills. Trained observers blind to treatment condition observed each child during recess on two separate days at baseline and again at posttreatment, using a structured behavioral observation system that generates frequency scores for observed social communication-related autism symptoms. CBT outperformed TAU at posttreatment on the frequency of self-isolation, the proportion of time spent with peers, the frequency of positive or appropriate interaction with peers, and the frequency of positive or appropriate peer responses to the target child (d effect size range 1.34-1.62). On average, children in CBT were engaged in positive or appropriate social interaction with peers in 68.6 % of observed intervals at posttreatment, compared to 25 % of intervals for children in TAU. Further investigation of this intervention modality with larger samples and follow-up assessments is warranted.

Wood, J. J., Fujii, C., Renno, P., & Dyke, M. (2014). Impact of cognitive behavioral therapy on observed autism symptom severity during school recess: a preliminary randomized, controlled trial. Journal Of Autism And Developmental Disorders. doi:10.1007/s10803-014-2097-7

Emotional Management Training CBT in Social Settings May Reduce Children’s Anxiety

A recent study published in the Journal of Research in Childhood Education, investigated the effect of using Cognitive Behavior Therapy (CBT) in a social setting on children’s anxiety levels. Typically, children with anxiety have the most difficulty with evaluating and managing emotions, which may lead to poor peer relationships and maladaptive coping strategies. Because anxiety disorders are the most common mental health conditions in children, research on early intervention is warranted. Emotional Management Training (EMT) is a form of CBT that helps children learn to regulate anxious emotions. Participants in the current study were primarily recruited from a New York City mental health clinic and included 58 children, ages 5-14, diagnosed with anxiety disorders. The program included social and therapeutic group activities, as well as CBT skills to help children manage anxious emotions. Specifically, the EMT CBT intervention consisted of psychoeducation about emotional and physical anxiety symptoms, relaxation and meditation therapy, cognitive restructuring, and exposure activities. Results demonstrated overall improvement in anxiety symptoms measured by the Multidimensional Anxiety Scale for Children, program satisfaction surveys, self-reports, and therapist and parent reports. These findings suggest that EMT may be a helpful alternative for anxious children in social settings.

Kearny, R., Pawlukewicz, J., & Guardino, M. (2014). Children with anxiety disorders: Use of a cognitive behavioral therapy model within a social milieu. Journal of Research in Childhood Education, 28, 59-68. doi: 10.1080/02568543.2013.850130

CBT is Effective for Childhood Obesity

According to a recent study published in Quality of Life Research, Cognitive Behavior Therapy (CBT) can be effective in reducing obesity and increasing health-related quality of life (HRQOL) in children. The current study, based in the Netherlands, sought to assess the effects of a family-based multidisciplinary CBT, aimed at reducing Body Mass Index (BMI) and improving quality of life in obese children in comparison to standard care. Those who participated (n=81) ranged in age from 8 to 17 years. The children were randomly assigned to receive the multidisciplinary CBT intervention (n=41) or care as usual (n=40), including advice regarding nutrition and physical activity. The intervention consisted of a 3 month screening phase involving a dietician, child-physiotherapist and child-psychologist. Afterward, there was a 3 month intensive phase consisting of group meetings for the children and their parents. Treatment was also followed by booster sessions; totaling a period of 2 years.

Following 3 months of treatment and at the 12-month follow up, multidisciplinary CBT was found to be statistically significant in reducing the BMI of participants. An ANCOVA test showed a decline from 4.2 BMI-Standard Deviation Score (SDS) at baseline to 3.8 BMI-SDS at the 12-month follow-up; there was no change in the BMI-SDS of the control group.  Analysis for health-related quality of life was based on child report (DISABKIDS) as well as parent report. Immediately following the intervention there were improvements in quality of life as measured by the HRQOL, though non-significant at that time. However, the results from baseline to the 12-month follow up showed that there was a statistically significant increase in quality of life, both physically and emotionally.

This study is important as it shows the longitudinal effects of a Multidisciplinary CBT, whereas most similar studies have only shown short term effects. Though further longitudinal studies of this kind are needed, the results suggest that a family-based multidisciplinary CBT can be an effective treatment for reducing BMI and increasing health-related quality of life in children suffering with obesity.

Vos, R.C., Huisman, S.D., Houdijk, E.C.A.M., Pijl, H., & Wit, J.M. (2012) The effect of family-based multidisciplinary cognitive behavioral treatment on health-related quality of life in childhood obesity.  Quality of Life Research, 21(9), 1587-1594

CBT for Childhood Trauma

In this video from Beck Institute’s recent CBT Workshop for Students and Faculty, Dr. Aaron Beck summarizes the process of treating patients who have experienced childhood trauma. Analyzing childhood experiences is an integral part of developing cognitive formulations of many individual patients, especially those with Axis II disorders. Sharing this formulation with patients often helps them to modify their maladaptive beliefs about themselves. In some cases, it is necessary for patients to relive a traumatic childhood experience (via imaginal exercises) to help them formulate an objective, dispassionate view of their experience at both the intellectual and emotional level.

Beck Institute hosts specialized workshops throughout the year including, CBT for Children and Adolescents. For more information, visit our website.

 

Child and adolescent Anxiety: Most effective treatments combine CBT and pharmacotherapy

Authors of a new study in the New England Journal of Medicine reported that anxiety disorders in children and adolescents negatively affect school performance, family relations, and social functioning. Despite a high prevalence (10-20%), they are largely “underrecognized and undertreated.” The anxiety disorders evaluated in this study included separation and generalized anxiety and social phobia. Cognitive behavioral therapy (CBT) and selective serotonin-reuptake inhibitors (SSRIs) have already been demonstrated to be effective in this group but a randomized controlled study of the two in combination has been lacking.

To address this, children ranging in age from 7 to 17 received CBT, an SSRI (sertraline/Zoloft) or placebo, or a combination of the CBT and sertraline. The CBT involved fourteen 60-minute sessions and included anxiety-management skills and behavioral exposure to anxiety-provoking situations.

The authors found that improvement was greatest for the combination therapy (80.7%), followed by cognitive behavioral therapy alone (59.7%), then sertraline alone (54.9%), and all therapies were superior to placebo (23.7%). An interesting additional finding was that “there was less insomnia, fatigue, sedation, and restlessness associated with cognitive behavioral therapy than with sertraline.”

The authors concluded that “all three of the treatment options may be recommended, taking into consideration the family’s treatment preferences, treatment availability, cost, and time burden.”

Study authors: J. T. Walkup, A.M. Albano, J. Piacentini, B. Birmaher, et al.