Running Head: COGNITIVE-BEHAVIOURAL TREATMENT 1

Project Proposal: Coping Cat

Ocanne Arsenault Perron

Wednesday, November 30th, 2016

Background Information

I am currently doing my field placement in a school that implements individualized and

developmentally-based curriculum within the classroom. Some students have special needs and

exceptionalities and every individual's learning style and level is attended to, which promotes
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child-centered care and optimizes development.

I noticed there are many students that have difficulty regulating their emotions and have

behaviour issues. Many of the students require more support to complete daily tasks and need

encouragement to engage in positive behaviour. There are a few students in this classroom that

have anxiety disorders, some of which being comorbid disorders with other diagnoses. One

student is diagnosed with Attention Deficit Hyperactivity Disorder and Aspergers Syndrome and

displays symptoms of anxiety including, becoming easily frustrated, has difficulty completing

work, has inconsistent patterns in antecedents, acts out spontaneously, (Minahan & Rappaport,

2012, para. 6), increase in special interest, [and] becoming easily explosive (Minahan &

Rappaport, 2012, para. 7). Moreover, there is a student who is diagnosed with Obsessive-

Compulsive Disorder and Generalized Anxiety Disorder. Finally, another student displays

symptoms of anxiety, such as trouble focusing and excessive worry (KidsHealth, 2016).

Although there is a behaviour therapist that helps students when they are experiencing

emotion dysregulation or other behaviour management concerns, anxiety isnt particularly

addressed. The behaviour therapist typically focuses on responding to problematic behaviours

and help students calm down. After discussing my observations with the director of the school,

she suggested I implement the cognitive-behavioural therapy program called Coping Cat to teach

these students how to cope with their anxiety. One student began Coping Cat with a psychiatrist,

but due to certain circumstances, was unable to continue attending treatment sessions. The

Coping Cat treatment sessions can be done on an individual basis or in a group session, which

will allow me to build relationships with the students, as well as normalize their anxiety. During

the fall term, I have been working closely with these students to foster a sense of trust and
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comfort, which will translate into creating a safe and comfortable environment for the Coping

Cat treatment sessions, which is to start in January, during the winter semester.

Filling the Gap

According to Heriot et al., anxiety is a significant condition that impairs a substantial

number of children (2007). Anxiety can lead to avoidance of social interactions necessary for

healthy development, difficulties in peer relationships and impairment in school functioning

(Beidas et al., 2011). Untreated anxiety symptoms worsen over time and can be associated with

a host of negative sequelae, including later anxiety, depression (Beidas et al., 2011, p. 223). The

negative effects of anxiety disorders are apparent, and need to be addressed, to protect the health

and mental health of children. The emphasis of filling this area of need is evident when coming

across statistics, for instance, epidemiological data have indicated that by the age of 16 years,

9.9% of children will meet diagnostic criteria for an anxiety disorder (Heriot et al., 2007, para.

5).

Research indicates that, (1) girls experience more anxiety and greater difficulties

regulating their negative emotions than boys, and (2) emotion dysregulation has a significant

impact on anxiety. Not previously shown, (3) emotion dysregulation is more predictive of

anxiety in girls than in boys, and (4) different types of emotion regulation difficulties account for

anxiety in girls and boys (Bender et al., para. 1). Additionally, a number of studies have shown

a higher frequency and intensity of anxiety symptoms in female respondents, and so others argue

that anxiety problems, even at an early age, are more common in girls than in boys (Bender et

al., 2012, para. 2). The three participants that are going to be a part of the Coping Cat group are

girls, therefore, Coping Cat will teach them the skills and coping mechanisms they require to

attend to their intense anxious feelings.

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Potential Outcomes

In result of filling this area of need, the students with anxiety disorders will learn how to

maintain their anxious feelings, and utilize relaxation techniques to increase their daily

functioning within the classroom, as well as outside the school setting. The students will

potentially further their social skills by contributing to more positive peer interactions, as well as

their emotional domain through increased self-regulation in emotional regulation, behaviour

regulation, and attention regulation. Furthermore, a meta-analysis was conducted to evaluate the

effect of CBT on [quality of life] in patients with anxiety disorders (Boettcher et al., 2014, p.

375). This study concluded that CBT for anxiety disorders is moderately effective for improving

quality of life, especially in physical and psychological domains (Boettcher et al., 2014, p. 375),

and had a large effect on reducing anxiety symptoms (Boettcher et al., 2014, p. 387). Upon

successful completion of the Coping Cat program, it is expected that the cognitive-behavioural

therapy will decrease the chances of these young girls developing greater emotional non-

acceptance, lower emotional clarity, less access to effective emotion regulation strategies, as well

as greater difficulties engaging in goal-oriented behavior (Bender et al., 2012, para. 2).

The student with ADHD is currently taking medication, therefore taking this into

consideration is important when thinking about the potential outcomes of the program. A study

has been conducted to compare preexisting groups of medicated and non-medicated children

aged 813 years, with a primary diagnosis of an anxiety disorder, participating in a 12-session,

manualized cognitive-behavior therapy group (GCBT) Results suggested that both groups

showed a significant decrease in their anxiety symptoms from pre- to post-treatment and from

pre-treatment to 4-month follow-up, based on both child- and parent-report. No significant

differences in anxiety symptoms were found between the medicated and non-medicated groups
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at pre-, post-, or 4-month follow-up, suggesting that the two groups benefited similarly from

GCBT (Eichstedt et al., 2010, para. 1). This demonstrates that the effectiveness of the CBT will

not vary within the children, based on whether or not they are taking medication for their anxiety

or other diagnosis. Each student with an anxiety disorder will benefit from this treatment, which

will positively impact their daily lives and their overall well-being.

Objectives

The main components and objectives of Coping Cat are:

Recognize and understand physical and emotional reactions to anxiety

Clarifying thoughts and feelings in anxious situations

Developing plans for effective coping

Evaluating performance and giving self-reinforcement (The California Evidence-Based

Clearinghouse for Child Welfare, 2009, para. 2).

The programming of the cognitive-behavioural treatment helps children meet the objectives by

using these essential components:

Psychoeducation, involving information for children and families about how anxiety can

develop and be maintained, and how it can be treated

Exposure tasks, which give the child the chance to be in the feared situation and have a mastery

experience

Somatic management, which teaches relaxation techniques

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Cognitive restructuring which addresses FEAR: Feeling frightened, expecting bad things,

attitudes and actions that will help, and results and rewards

Problem solving to generate and evaluate specific actions for dealing with problems (The

California Evidence-Based Clearinghouse for Child Welfare, 2009, para. 3).

Each of these elements will help children work towards the main goal of Coping Cat, which is to

reduce anxiety (The California Evidence-Based Clearinghouse for Child Welfare, 2009).

Monitoring and Evaluation

I will be using the Screen for Child Anxiety Related Disorder (SCARED) assessment as a

screening instrument before implementing the cognitive-behaviour treatment. The scale

evaluates symptoms according to DSM-IV diagnostic criteria [13] for specific anxiety disorders

(social phobia, generalized anxiety disorder (GAD), separation anxiety disorder, panic disorder).

School anxiety, also measured by the SCARED Data from international studies have

consistently considered the SCARED to be a reliable and valid screening instrument to assess

anxiety symptoms in children and adolescents. (DeSousa et al., 2012, p.391) The SCARED

assessment will be used as a pre-and post-evaluation method of assessment and evaluation, in

order to be consistent. As a pre-evaluation tool, the SCARED assessment will provide me with

the opportunity to practice guiding the children completing the self-assessment, as well as give

me an idea of what kind of anxiety they may be experiencing. After the program implementation,

I will use the SCARED assessment a second time to evaluate whether the participants anxiety

symptoms have decreased. I will be able to do an analysis of the pre-evaluation and post-

evaluation to see how the program has affected the children and their symptoms of anxiety.

A longitudinal study will be done with the intervention group of students that will be
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involved in the Coping Cat treatment. This observational study will take place from January

2017 to March 2017, while I will be facilitating the program. I will be monitoring progress by

observing and analyzing if children can recognize the physical cues to their anxiety, developing

effective coping mechanisms and utilizing them in an anxiety-provoking situation throughout the

exposure tasks that will be given on a weekly basis. In addition, I will ask questions during the

sessions to check-in with the students, making sure this treatment is helpful to them. This type of

informal interview will serve as a method of data collection to ensure the goals and objectives of

Coping Cat are met, and evaluate the effectiveness of the program.
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References

Beidas, R. S., Benjamin, C. L., Cohen, J. S., Edmunds, J. M., Kendall, P. C., Mychailyszyn, M.

P., & Podell, J. L. (2011). Assessing and treating child anxiety in schools. Psychology in

the Schools 48 (3), 223-232. doi: 10.1002/pits.20548 Retrieved from

http://journals1.scholarsportal.info.subzero.lib.uoguelph.ca/pdf/00333085/v48i0003/223_a

atcais.xml

Bender, P. K., Esbjrn, B.H., Reinholdt-Dunne, M.L., & Pons, F. (2012). Emotion dysregulation

and anxiety in children and adolescents: Gender differences. Personality and Individual

Differences 53 (3), 284-288 Retrieved from

http://www.sciencedirect.com.subzero.lib.uoguelph.ca/science/article/pii/S0191886912001

444

Boettcher, H., Hofmann, S. G., & Wu, J. Q. (2014). Effect of cognitive-behavioral therapy for

anxiety disorders on quality of life: A meta-analysis. Journal of Consulting and Clinical

Psychology 82 (3), 375-391. doi: 10.1037/a0035491 Retrieved from

http://psycnet.apa.org.subzero.lib.uoguelph.ca/journals/ccp/82/3/375.pdf

DeSousa, D. A., Isolan, L. R., Manfro, G. G., & Salum, G. S. (2012). Sensitivity and specificity

of the screen for child anxiety related emotional disorders (SCARED): A community-based

study. Child Psychiatry Human Development 44, 391-399. doi: 10.1007/s10578-012-0333-

y Retrieved from

http://journals1.scholarsportal.info.subzero.lib.uoguelph.ca/pdf/0009398x/v44i0003/391_s

asotsredacs.xml
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Eichstedt, J.A., Phoenix, E., Tobon, J. I., & Wolfe, V. V. (2010). Worried no more: The effects of

medication status on treatment response to a CBT group for children with anxiety in a

community setting. Clinical Child Psychology 16 (2), 265-277. doi:

10.1177/1359104510366282 Retrieved from

http://journals2.scholarsportal.info.subzero.lib.uoguelph.ca/pdf/13591045/v16i0002/265_w

nmteowaiacs.xml

Heriot, S., Hunt, C., & Levy, K. (2007). Treating comorbid anxiety and aggression in children.

Journal of the American Academy of Child & Adolescent Psychiatry 46 (9), 1111-1118.

Retrieved from http://dx.doi.org.subzero.lib.uoguelph.ca/10.1097/chi.0b013e318074eb32

KidsHealth. (2016). Anxiety disorders. Retrieved from http://kidshealth.org/en/parents/anxiety-

disorders.html#

Minahan, J., & Rappaport, N. (2012). Anxiety in students: A hidden culprit in behavior issues:

Identifying the triggers for inappropriate behaviors and teaching children more desirable

responses can be part of intervention plans in any classroom. Phi Delta Kappan 94 (4), 34.

Retrieved from http://go.galegroup.com.subzero.lib.uoguelph.ca/ps/i.do?&id=GALE|

A313887159&v=2.1&u=guel77241&it=r&p=AONE&sw=w

The California Evidence-Based Clearinghouse for Child Welfare. (2009). Coping cat. Retrieved

from http://www.cebc4cw.org/program/coping-cat/detailed