Efficacy of acceptance-mindfulness therapy in children with anxiety: a controlled trial

INTERVENTION: 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. CONDITION: Anxiety Disorder PRIMARY OUTCOME: Clinically significant change in anxiety severity as measured by either ADIS‐IV, Multidimensional Anxiety Scale for Children (MASC; March, 1997) and/or Child Behaviour Checklist (CBCL) Mechanisms of change (adolescent participants only) as measured by changes in experiential avoidance, cognitive fusion, acceptance and valued living Presence of DSM‐IV Anxiety disorder as measured by the Anxiety Disorders Interview Schedule (ADIS‐IV) (Albano & Silverman, 1996) SECONDARY OUTCOME: Depression symptoms as measured by the Child Depression Inventory and/or Child Behaviour Checklist (CBCL) Quality of life and self‐efficacy as measured by the Childrens Anxiety Life Interference Scale Child Form (CALIS‐C) INCLUSION CRITERIA: 1) Aged between 7‐17 years 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 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