A "Cool Kids" Cognitive-Behavioral Therapy Group for Youth with Anxiety Disorders: Part 1, The Case of Erik

Abstract

This case study involves a 12-year-old boy, Erik, with cognitive difficulties, who also suffered from multiple anxiety disorders (specifically, he met the diagnostic criteria of Generalized Anxiety, Specific Phobias, Social Phobia, and Separation Anxiety). Erik and his family were treated for 10 sessions over three months with the "Cool Kids " cognitive-behavioral therapy (CBT) program developed by Ronald Rapee and his colleagues (Rapee et al., 2006). The treatment took place in a university training clinic in Aarhus, Denmark. CBT was conducted in a group format, with both children and their families taking an active part, and included cognitive restructuring, gradual exposure, child management training, and skills training in areas such as assertiveness. Results show that therapy effectively reduced the child’s anxiety symptoms, as measured by the Anxiety Disorder Interview Schedule for Children and Parents (ADIS-IV P/C) and by the Spence Children's Anxiety Scale (SCAS). Additional quantitative and qualitative data indicate an overall positive therapeutic outcome, which was maintained at 3 months and 15 months after the conclusion of treatment. A primary aim of the case study was to investigate the mechanisms of change leading to success in Erik's case, focusing on the role of parental inclusion in the therapy and the necessary accommodations made to the child’s cognitive developmental level. For example, through parents’ engagement in therapy, it was possible to alter their expectations and behaviors, with Erik’s mother learning how to be less overprotective and control her own anxiety, functioning as a positive role model for her child. Furthermore, the present study stresses the significance of accommodating the treatment to the child’s cognitive developmental level, such that Erik’s cognitions were initially challenged successfully through gradual exposures and only later addressed with cognitive restructuring, aided by the treatment given to his parents and Erik’s advancing cognitive maturation.