None listed
Conditions
Brief summary
Over the last 15 years mindfulness and acceptance therapies have taken hold in psychology as a new era of treatment. Acceptance-mindfulness therapies differ from traditional cognitive behavioural therapies (CBT) in that rather than attempting to change the content, frequency and form of thoughts and feelings, acceptance or mindfulness-based therapies seek to change the functions of thoughts, feelings and physical sensations so as to minimise their impact. While there is growing empirical support for the utility of acceptance-mindfulness treatments for adults with anxiety and other psychological problems, very little research has been conducted on children evaluating its effectiveness despite the growing use in children and adolescents. This study aims to conduct a controlled clinical trial evaluating the efficacy of acceptance-mindfulness therapy for children with anxiety disorders. Children aged 7-17 years will be randomly allocated to one of 3 groups: acceptance-mindfulness integrated with cognitive behavioural therapy, cognitive behavioural therapy only, and a waiting list control group. Repeated measures of psychological outcomes will be taken pre, immediate post and 3 months post-treatment. Parents will also undertake group therapy sessions while the children are undergoing therapy to assist children transfer the skills to everyday life.
Interventions
Arm 1: Acceptance and Commitment Therapy group-based manualised therapy program delivered as 10 x 1.5 hour sessions over 10 weeks, involving up to 8 children and their caregivers in each group. The ACT program will involve the 'Cool Mind' and 'Mindchill' programs, developed at The Children’s Hospital at Westmead, for children aged 7-11 years and 12-17 years, respectively. They are both ACT-based adaptations of Cool Kids and Chilled programs, described below, and were designed to conform to the o
Arm 1: Acceptance and Commitment Therapy group-based manualised therapy program delivered as 10 x 1.5 hour sessions over 10 weeks, involving up to 8 children and their caregivers in each group. The ACT program will involve the 'Cool Mind' and 'Mindchill' programs, developed at The Children’s Hospital at Westmead, for children aged 7-11 years and 12-17 years, respectively. They are both ACT-based adaptations of Cool Kids and Chilled programs, described below, and were designed to conform to the overarching structure of these programs for comparison purposes. These ACT programs were developed on the basis of ACT-consistent protocols adapted from Lee and Semple’s (2008) Mindfulness-Based Cognitive Therapy for Children protocol; Murrell and Wilson’s Acceptance and Commitment Therapy Adapted for Children (Murrell & Wilson, 2003), Cayoun’s MiCBT protocol (Cayoun, 2009), and Harris’ ACT Mindfully Workshops (Harris, 2007). This program incorporates all six ACT core therapeutic processes that target psychopathology (as described above) including Acceptance, Being Present/Mindfulness, Valued directions, Committed Action, Self-as-context and Cognitive Defusion. In Mindchill, adolescents will learn skills to manage the distress associated with anxious thoughts and feelings. For example, rather than the CBT approach to fighting anxiety and being in control, this program will concentrate on anxiety management via supporting adolescents to identify their values and behave in a value-consistent way, whilst encouraging acceptance of anxious thoughts and feelings that may arise in the process of doing so. Arm 2: Cognitive Behaviour Therapy (CBT) group-based manualised therapy program delivered as 10 x 1.5 hour sessions over 10 weeks, involving up to 8 children and their caregivers in each group. The CBT program will entail the Cool Kids and Chilled (Registered Trademark) programs - for children aged 7-11 years and 12-17 years, respectively - developed at Macquarie University (Rapee et al., 2006). Cool Kids and Chilled (Registered Trademark) assist children to learn skills to recognise their emotions and combat anxiety, encouraging brave behaviour and gradual engagement with feared situations. One section of the Chilled (Registered Trademark) Program “worry wave” will be omitted from the program for the purposes of this research as it was considered to have mindfulness components more consistent with an ACT approach. This is a small component of the overall program.
Sponsors
Children's Hospital Westmead, Department of Psychological Medicine
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Treatment
Masking
Blinded (masking used)
Eligibility
Sex/Gender
All
Age
7 Years to 17 Years
Healthy volunteers
No
Inclusion criteria
1) Aged between 7-17 years 2) Meet criteria for a primary diagnosis of a Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) anxiety disorder (including panic disorder and/or agoraphobia, obsessive compulsive disorder, specific phobia, social anxiety disorder or generalised anxiety disorder) 3) Available/able to attend The Children’s Hospital at Westmead for pre-treatment, immediate post-treatment and three month post-treatment assessments as well as attending a minimum of 80% of therapy sessions 4) Have a parent/caregiver who is willing to attend and participate in the assessment as well as a minimum of 80% of therapy sessions
Exclusion criteria
1) Developmental or language delay, as reported by parent/caregiver 2) Non-English speakers 3) Complex mental health problems such as psychosis, conduct disorder or active suicidality 4) Complex medical conditions with a high degree of medical dependence that would prevent them from being able to attend at least 80% of sessions 5) Attention deficit disorder with hyperactivity that is not well controlled 6) Medicated with an anxiolytic/antidepressant for less than 2 months 7) Post-traumatic stress disorder (due to the potential distress caused to other participants in the group and the specialised treatment required for this disorder) 8) Completed < 80% of sessions or dropped out of treatment – Those who become lost to follow-up will be placed in the ’intention to treat’ category
Outcome results
None listed