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Adapting the Brief Coping Cat for Children with Anxiety to a Group Setting in the Spanish Public Mental Health System: a Hybrid Effectiveness-Implementation Pilot Study

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Abstract

Group therapy may offer a promising solution to reducing patient waiting lists for publicly funded mental health services. In this study, an individual brief cognitive behavioral therapy (BCBT) intervention was adapted for implementation in a group setting in the Spanish public mental health care system. The study was designed to test initial clinical effectiveness, acceptability, and feasibility of the group adaptation of BCBT for child anxiety. The study utilized an uncontrolled multiple-group design for 8 weeks (1 h per week). Inclusion criteria were (i) children and young adolescents between 8 and 15 years old, and (ii) a clinical diagnosis of general anxiety disorder, social phobia, and/or separation anxiety disorder. Five groups were completed (n = 33; mean age = 11 years; 42.4% females). A total of 31 (93.9%) participants completed at least 7 sessions, and follow-up data were collected for 84.9% (n = 28) of participants. Overall, anxiety symptoms were reduced after intervention on the Spence Children Anxiety Scale, Generalized Anxiety Disorder Questionnaire-IV, Social Anxiety Scale for Children-Revised, and Separation Anxiety Symptom Inventory. Our findings suggest that group BCBT was associated with beneficial treatment outcomes, was acceptable and feasible for children with anxiety in the Spanish public mental health system. Both participants and their caregivers reported satisfaction and feelings of safety with the intervention. Results underscore the need for a larger-scale hybrid effectiveness-implementation trial of BCBT in a group setting throughout more community mental health centers in different Spanish states. Such work could improve patient access to and benefit from an evidence-based treatment that works in community settings.

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Acknowledgements

The authors acknowledge all the clinicians involved in providing the intervention as co-therapists: David Rentero-Martin, Patricia Nava-García, Sergio Benavente-López, Esther Martín-Ávila, Odei Iriondo-Villaverde, Manuel Nieves-Carnicer, and the rest of child and adolescent clinicians from the Mental Health Centers Villaverde and Carabanchel for assisting with participant recruitment. Finally, the authors would like to thank all the participating children and their families for their involvement with the intervention.

Funding

O.S.-E., the first author, was supported by a Research Fellowship from the Alicia Koplowitz Foundation (Spain) and an Endeavour Research Fellowship (Australia). S.M.R. was supported via the Mary Elizabeth Watson Early Career Fellowship in Allied Health, provided by Melbourne Health.

Author Contributions

O.S.-E.: designed and executed the study, analyzed the data, and wrote the paper. L.H.-A.: collaborated with the design and execution of the study as a co-therapist of the groups. S.M.R.: assisted with the analyses and editing of the study. M.J.G.-L., M.S.-V., and J.C.E.-J.: collaborated with the design and writing of the study. M.A.J.-A.: collaborated in the editing of the final manuscript.

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Authors and Affiliations

  1. Hospital Universitario 12 de Octubre, Madrid, Spain

    Olga Santesteban-Echarri, Laura Hernández-Arroyo, M. José Güerre-Lobera, José Carlos Espín-Jaime & Miguel Ángel Jiménez-Arriero

  2. Facultad de Ciencias de la Salud, Universidad Internacional de la Rioja (UNIR), Madrid, Spain

    Olga Santesteban-Echarri

  3. Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC, Australia

    Simon M. Rice

  4. Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia

    Simon M. Rice

  5. Instituto Psiquiátrico José Germain de Leganes, Madrid, Spain

    María Serrano-Villar

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  1. Olga Santesteban-Echarri
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Correspondence to Olga Santesteban-Echarri.

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We have complied with APA ethical standards in the treatment of all participants, and the research protocol was approved by Hospital Universitario 12 de Octubre Research Ethics Committee. All parents provided informed consent for their children to participate in the study and assent was obtained from the participating children. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Santesteban-Echarri, O., Hernández-Arroyo, L., Rice, S.M. et al. Adapting the Brief Coping Cat for Children with Anxiety to a Group Setting in the Spanish Public Mental Health System: a Hybrid Effectiveness-Implementation Pilot Study. J Child Fam Stud 27, 3300–3315 (2018). https://doi.org/10.1007/s10826-018-1154-9

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