Category: Research Methods and Statistics
Cognitive Behavioral Therapy (CBT) has been shown to be highly efficacious in randomized controlled studies of clinically anxious children (In-Albon & Schneider, 2007). However, studies rarely assess how frequently and effectively children use the skills they learn in CBT, such as emotion identification and cognitive restructuring, in their daily life. We adapted a new real-world skills assessment tool, the Skill-use Internet Diary (SID)-Anxiety Version (Parent report) to examine whether there are changes in CBT skill-use associated with treatment for anxiety. The SID was originally used to assess skills learned in interventions for behavioral disorders, but was adapted to be applicable to skills learned in the treatment of anxiety disorders in children. The SID assessment asks parents to identify topics their children worried about that day, select the skill (or report no skill used) their child used to reduce their anxiety about this worry or fear, and rate if the strategy appeared to make the child feel better. We hypothesized that there would be pre-to post-treatment reductions in the number of parent-reported worries, and increases in use of CBT skills to reduce anxiety (i.e. emotion identification, cognitive reframing, approaching feared situations). Furthermore, we predicted greater use of coping strategies would be associated with treatment response.
We collected data using the SID in 31 clinically anxious youth (ages 9-14, 15 females) for 7 consecutive days before and after receiving eight weeks of CBT. Parents were prompted to complete the SID once a day via text messages that included a link to an online diary. Paired t-tests revealed that the number of worries parents identified was significantly reduced pre-to-post-treatment, t(1,30)=6.45, p < .01. Parents reported increased use of coping strategies overall, though this finding was non-significant t(1,30)=1.73, p = .09. Use of cognitive reframing was positively associated with no diagnosis at post-treatment, r = .43, p = .03, indicating that children who used cognitive reframing more often were more likely to recover. Findings indicate that some aspects of the SID were sensitive to change over the course of CBT and treatment response. These results provide evidence that the SID is useful in evaluating if CBT skills are being utilized in daily life.