Trends in Psychiatry and Psychotherapy
https://trends.org.br/article/doi/10.1590/2237-6089-2016-0047
Trends in Psychiatry and Psychotherapy
Original Article

Eclectic approach to anxiety disorders among rural children

Abordagem eclética a transtornos de ansiedade em crianças de zona rural

Atefeh Ahmadi; Mohamed Sharif Mustaffa; Ali Akbar Haghdoost; Syed Mohamed Shafeq Mansor

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Abstract

Abstract Introduction Anxiety disorders in primary school-aged children negatively affect their mental health and psychological development. Available non-medical treatments for these conditions are time-consuming and expensive. In this context, eclectic therapy is a therapeutic approach that incorporates some therapeutic techniques and philosophies to create the ideal treatment. In this study, eclectic therapy consisted of art therapy and cognitive-behavioral therapy designed for children suffering from high level of anxiety in their middle childhood years. The therapy also included group guidance sessions for their mothers. The effectiveness of this intervention was examined in the study. Methods 61 students aged 9-12 years with high levels of anxiety participated in the study. Intervention A (n = 20) consisted of 9-hour eclectic therapy for children with 3-hour group guidance sessions for their mothers. Intervention B (n = 20) consisted of 9-hour eclectic therapy for children. There was also a control group (n = 21). Results Teacher ratings of children’s mental health difficulties and self-report ratings of anxiety disorders indicated a significant difference from pretest to posttest, revealing a large effect size between the two interventions. Higher levels of pretest scores significantly predicted higher posttest scores for all domains of anxiety and mental health difficulties. Furthermore, age, gender, mothers working a 15-hour day, mother’s educational level, parental divorce rates, parental death, and family monthly income predicted therapy outcomes. Conclusion Results provide support for the effectiveness of eclectic art and CBT to improve children’s mental health and reduce anxiety through changing thoughts, beliefs, emotions, and behaviors that may cause fear and anxiety.

Keywords

Anxiety disorders, children, Spence Children’s Anxiety Scale, eclectic therapy, SDQ, CBT

Resumo

Resumo Introdução Transtornos de ansiedade em escolares afetam sua saúde mental e seu desenvolvimento psicológico. Tratamentos alternativos disponíveis consomem tempo e são dispendiosos. Nesse contexto, a terapia eclética é uma abordagem terapêutica que incorpora algumas técnicas e filosofias terapêuticas para criar o tratamento ideal. Neste estudo, terapia eclética consistiu de terapia artística e terapia cognitivo-comportamental (TCC) planejada para escolares com altos níveis de ansiedade. A terapia também incluiu sessões de orientação em grupo para as mães. A eficácia da intervenção foi examinada. Métodos 61 escolares com idade de 9-12 anos e altos níveis de ansiedade participaram do estudo. A intervenção A (n = 20) consistiu de 9 horas de terapia eclética para crianças com sessões de 3 horas de orientação em grupo para as mães. A intervenção B (n = 20) consistiu de 9 horas de terapia eclética para crianças. Houve também um grupo controle (n = 21). Resultados Escores atribuídos pelos professores às dificuldades de saúde mental das crianças e escores de ansiedade autoaplicados indicaram diferenças significativas entre resultados pré-teste e pós-teste, revelando grande tamanho de efeito entre as duas intervenções. Escores pré-teste maiores foram preditores significativos de escores pós-teste mais altos para todos os domínios de ansiedade e dificuldades de saúde mental. Idade, gênero, mães trabalhando 15 horas/dia, nível educacional da mãe, índice de divórcio, morte de um dos pais e renda familiar mensal foram preditores de desfechos da terapia. Conclusão Os resultados sugerem a eficácia de arte eclética e TCC para melhorar a saúde mental de crianças e reduzir a ansiedade através de mudança em pensamentos, crenças, emoções e comportamentos que possam causar medo e ansiedade.

Palavras-chave

Transtornos de ansiedade, crianças, Spence Children’s Anxiety Scale, eclectic therapy, SDQ, CBT

References

Abbo C, Kinyanda E, Kizza RB, Levin J, Ndyanabangi S, Stein DJ. Prevalence, comorbidity and predictors of anxiety disorders in children and adolescents in rural north-eastern Uganda. Child Adolesc Psychiatry Ment Health. 2013;7.

Anderson NJ, Neuwirth SJ, Lenardson JD, Hartley D. Patterns of care for rural and urban children with mental health problems. 2013.

Mychailyszyn MP, Beidas RS, Benjamin CL, Edmunds JM, Podell JL, Cohen JS. Assessing and treating child anxiety in schools. Psychol Sch. 2011;48:223-32.

Drake KL, Ginsburg GS. Family factors in the development, treatment, and prevention of childhood anxiety disorders. Clin Child Fam Psychol Rev. 2012;15:144-62.

James AC, James G, Cowdrey FA, Soler A, Choke A. Cognitive behavioural therapy for anxiety disorders in children and adolescents. Cochrane Database Syst Rev. 2013;6.

Sones HM, Thorp SR, Raskind M. Prevention of post traumatic stress disorder. Psychiatr Clin North Am. 2011;34:79-94.

Lundkvist-Houndoumadi I, Hougaard E, Thastum M. Pre-treatment child and family characteristics as predictors of outcome in cognitive behavioural therapy for youth anxiety disorders. Nord J Psychiatry. 2014;68:524-35.

James A, Soler A, Weatherall R. Cognitive behavioural therapy for anxiety disorders in children and adolescents. Cochrane Database Syst Rev. 2005;4.

Öst LG. Cognitive behavior therapy for anxiety disorders: 40 years of progress. Nord J Psychiatry. 2008;62:5-10.

Victor AM, Bernat DH, Bernstein GA, Layne AE. Effects of parent and family characteristics on treatment outcome of anxious children. J Anxiety Disord. 2007;21:835-48.

Malchiodi CA, Rozum AL. Cognitive-behavioral and mind–body approaches. Handbook of art therapy. 2012:89-103.

Otte C. Cognitive behavioral therapy in anxiety disorders: current state of the evidence. Dialogues Clin Neurosci. 2011;13:413-21.

Campbell MA. Innovative ways to assist young anxious children. Sensitivity and childhood trauma. 2009:76-88.

Smokowski PR, Cotter KL, Robertson CI, Guo S. Anxiety and aggression in rural youth: baseline results from the rural adaptation project. Child Psychiatry Hum Dev. 2013;44:479-92.

Sridevi K. A study of relationship among general anxiety, test anxiety and academic achievement of higher secondary students. J Educ Pract. 2013;4:122-30.

Yen CF, Ko CH, Wu YY, Yen JY, Hsu FC, Yang P. Normative data on anxiety symptoms on the Multidimensional Anxiety Scale for children in Taiwanese children and adolescents: differences in sex, age, and residence and comparison with an American sample. Child Psychiatry Hum Dev. 2010;41:614-23.

Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). 2013.

Lyneham HJ, Rapee RM. Childhood anxiety in rural and urban areas: presentation, impact and help seeking. Aust J Psychol. 2007;59:108-18.

Vakilian S, Ghanbari BA. Effectiveness of compound group cognitive-behavioral therapy and social skill training on fear of negatitive assessment and social avoidance. J Clin Psychol. 2009;1:11-28.

Gardner H. Frames of mind: Theory of multiple intelligences. 1983.

Gardner. H. Multiple intelligences. New horizons. 2006.

Gardner H, Moran S. The science of multiple intelligences theory: a response to Lynn Waterhouse. Educ Psychol. 2006;41:227-32.

Cooper M. The challenge of counselling and psychotherapy research. Couns Psychother Res. 2010;10:183-91.

Pearson M. Multiple intelligences, eclecticism and the therapeutic alliance: New possibilities in integrative counsellor education. 2012.

Lazarus AA, Beutler LE. On technical eclecticism. J Couns Dev. 1993;71:381-5.

Shilling HN. How integrative and eclectic therapists make treatment selection decisions: a qualitative study. 2012.

Prochaska JO, Norcross JC. Systems of psychotherapy: a transtheoretical analysis. 2010.

Norcross JC. A primer on psychotherapy integration. Handbook of psychotherapy integration. 2005.

Brooks-Harris JE. Integrative multitheoretical psychotherapy. 2008.

Taylor OD. Children of substance-abusing or substance-dependent parents. J Hum Behav Soc Environ. 2011;21:727-43.

Paul J. Evaluating the impact of a universal FRIENDS for Life Programme on emotional distress and academic self-perceptions. 2011.

Buchalter S. Raising self-esteem in adults: an eclectic approach with art therapy, CBT and DBT based techniques. 2014.

Wethington HR, Hahn RA, Fuqua-Whitley DS, Sipe TA, Crosby AE, Johnson RL. The effectiveness of interventions to reduce psychological harm from traumatic events among children and adolescents: a systematic review. Am J Prev Med. 2008;35:287-313.

Babatunde JO, Osakinle EO. Effects of group guidance and counselling techniques on students’vocational maturity in ekiti state secondary schools, Ekiti State, Nigeria. Eur Sci J. 2013:9478-84.

Owuamanam T. A handbook of guidance and counselling. 2007.

Dowell KA, Ogles BM. The effects of parent participation on child psychotherapy outcome: a meta-analytic review. J Clin Child Adolesc Psychol. 2010;39:151-62.

Pahl KM, Barrett PM, Gullo MJ. Examining potential risk factors for anxiety in early childhood. J Anxiety Disord. 2012;26:311-20.

Cohen JA, Bukstein O, Walter H, Benson RS, Chrisman A, Farchione TR. Practice parameter for the assessment and treatment of children and adolescent with posttraumatic stress disorder. J Am Acad Child Adolesc Psychiatry. 2010;49:414-30.

Liu J, Chen X, Lewis G. Childhood internalizing behaviour: analysis and implications. J Psychiatr Ment Health Nurs. 2011;18:884-94.

Knight A, McLellan L, Jones M, Hudson J. Pre-treatment predictors of outcome in childhood anxiety disorders: a systematic review. Psychopathol Rev. 2014;1:77-129.

Rapee RM. Family factors in the development and management of anxiety disorders. Clin Child Fam Psychol Rev. 2012;15:69-80.

Nilsen TS, Eisemann M, Kvernmo S. Predictors and moderators of outcome in child and adolescent anxiety and depression: a systematic review of psychological treatment studies. Eur Child Adolesc Psychiatry. 2013;22:69-87.

Southam-Gerow MA, Kendall PC, Weersing VR. Examining outcome variability: correlates of treatment response in a child and adolescent anxiety clinic. J Clin Child Psychol. 2001;30:422-36.

Rapee RM, Schniering CA, Hudson JL. Anxiety disorders during childhood and adolescence: origins and treatment. Annu Rev Clin Psychol. 2009;5:311-41.

Reynolds S, Wilson C, Austin J, Hooper L. Effects of psychotherapy for anxiety in children and adolescents: a meta-analytic review. Clin Psychol Rev. 2012;32:251-62.

Barrett PM, Farrell L, Pina AA, Peris TS, Piacentini J. Evidence-based psychosocial treatments for child and adolescent obsessive–compulsive disorder. J Clin Child Adolesc Psychol. 2008;37:131-51.

Ahmadi A, Mustaffa MS, Haghdoost A, Khan A, Latif AA. Cross-cultural adaptation of the Spence Children’s Anxiety Scale in Malaysia. Trends Psychiatry Psychother. 2015;37:37-41.

Ahmadi A, Mustaffa MS, Udin A, Haghdoost A. DSM-IV-defined anxiety disorder symptoms in a middle-childhood-aged group of Malaysian children using the Spence Children’s Anxiety Scale. Trends Psychiatry Psychother. 2016;38:14-22.

Spence SH, Barrett PM, Turner CM. Psychometric properties of the Spence Children’s Anxiety Scale with young adolescents. J Anxiety Disord. 2003;17:605-25.

Essau CA, Anastassiou-Hadjicharalambous X, Muñoz LC. Psychometric properties of the Spence Children’s Anxiety Scale (SCAS) in Cypriot children and adolescents. Child Psychiatry Hum Dev. 2011;42:557-68.

Ishikawa S, Sato H, Sasagawa S. Anxiety disorder symptoms in Japanese children and adolescents. J Anxiety Disord. 2009;23:104-11.

Essau CA, Muris P, Ederer EM. Reliability and validity of the Spence Children’s Anxiety Scale and the screen for child anxiety related emotional disorders in German children. J Behav Ther Exp Psychiatry. 2002;33:1-18.

Nauta MH, Scholing A, Rapee RM, Abbott M, Spence SH, Waters A. A parent-report measure of children’s anxiety: psychometric properties and comparison with child-report in a clinic and normal sample. Behav Res Ther. 2004;42:813-39.

Hernández-Guzmán L, Bermúdez-Ornelas G, Spence SH, Montesinos MJG, Martínez-Guerrero JI, Villalobos JA. Versión en español de la Escala de Ansiedad para Niños de Spence (SCAS). Rev Latinoam Psicol. 2010;42:13-24.

Richter J, Sagatun Å, Heyerdahl S, Oppedal B, Røysamb E. The Strengths and Difficulties Questionnaire (SDQ) - self-report. An analysis of its structure in a multiethnic urban adolescent sample. J Child Psychol Psychiatry. 2011;52:1002-11.

Shahrivar Z, Tehrani-Doost M, Pakbaz B, Rezaie A, Ahmadi F. Normative data and psychometric properties of the parent and teacher versions of the strengths and difficulties questionnaire (SDQ) in an Iranian community sample. J Res Med Sci. 2009;14:69-77.

Goodman A, Goodman R. Population mean scores predict child mental disorder rates: validating SDQ prevalence estimators in Britain. J Child Psychol Psychiatry. 2011;52:100-8.

Headley C, Campbell MA. Teachers’ recognition and referral of anxiety disorders in primary school children. Aust J Educ Dev Psychol. 2011;11:78-90.

Ethical principles of psychologists and code of conduct. 2010.

Bodden DH, Bögels SM, Muris P. The diagnostic utility of the screen for child anxiety related emotional disorders-71 (SCARED-71). Behav Res Ther. 2009;47:418-25.

Rabin AS. The experiences of children who participate in therapy incorporating art as a therapeutic medium. 2012.

Rubin JA. Child art therapy. 2011.

Loades ME, Mastroyannopoulou K. Teachers’ recognition of children’s mental health problems. Child Adolesc Ment Health. 2010;15:150-6.

Campbell ER. The effectiveness of art therapy in reducing symptoms of trauma, anxiety, and stress: a meta-analysis. 2010.

Pereira AI, Marques T, Russo V, Barros L, Barrett P. Effectiveness of the friends for life program in portuguese schools: study with a sample of highly anxious children. Psychol Sch. 2014;51:647-57.

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