ABSTRACT
BACKGROUND: The objective of this study is to assess group differences in symptom reduction between individuals receiving group cognitive behavioral therapy (G-CBT) and attention bias modification (ABM) compared to their respective control interventions, control therapy (CT), and attention control training (ACT), in a 2 × 2 factorial design. METHODS: A total of 310 treatment-naive children (7-11 years of age) were assessed for eligibility and 79 children with generalized, separation or social anxiety disorder were randomized and received G-CBT (n = 42) or CT (n = 37). Within each psychotherapy group, participants were again randomized to ABM (n = 38) or ACT (n = 41) in a 2 × 2 factorial design resulting in four groups: G-CBT + ABM (n = 21), G-CBT + ACT (n = 21), CT + ABM (n = 17), and CT + ACT (n = 20). Primary outcomes were responder designation as defined by Clinical Global Impression-Improvement (CGI-I) scale (≤2) and change on the Pediatric Anxiety Rating Scale (PARS). RESULTS: There were significant improvements of symptoms in all groups. No differences in response rates or mean differences in PARS scores were found among groups: G-CBT + ABM group (23.8% response; 3.9 points, 95% confidence interval [CI] -0.3 to 8.1), G-CBT + ACT (42.9% response; 5.6 points, 95% CI 2.2-9.0), CT + ABM (47.1% response; 4.8 points 95% CI 1.08-8.57), and CT + ACT (30% response; 0.8 points, 95% CI -3.0 to 4.7). No evidence or synergic or antagonistic effects were found, but the combination of G-CBT and ABM was found to increase dropout rate. CONCLUSIONS: We found no effect of G-CBT or ABM beyond the effects of comparison groups. Results reveal no benefit from combining G-CBT and ABM for anxiety disorders in children and suggest potential deleterious effects of the combination on treatment acceptability.
Subject(s)
Anxiety Disorders/therapy , Attentional Bias , Cognitive Behavioral Therapy/methods , Psychotherapy, Group , Brief Psychiatric Rating Scale , Child , Double-Blind Method , Female , Humans , MaleABSTRACT
This study examined the psychometric properties of the Spence Children's Anxiety Scale (SCAS) self- and parent-report versions in a community (n=712) and a clinical (n=70) sample of Brazilian children and adolescents. Confirmatory factor analysis conducted in the community sample provided support to the original six correlated factors model of the SCAS. Moreover, the SCAS demonstrated good internal consistency, convergent and divergent validity, and a significant informant effect on the total score with higher anxiety levels in the self-report than in the parent-report version. Considering the clinical sample, we could demonstrate that the SCAS total scores have good discriminant validity differentiating: (a) anxious, community, and negative screening groups; and (b) children diagnosed with different severity levels of anxiety disorders. Our findings suggest that the SCAS (self- and parent-report versions) is suitable for assessing anxiety symptoms in Brazilian children and adolescents in community and clinical settings.
Subject(s)
Anxiety Disorders/diagnosis , Anxiety/diagnosis , Psychiatric Status Rating Scales , Adolescent , Anxiety/psychology , Anxiety Disorders/psychology , Brazil , Child , Factor Analysis, Statistical , Female , Humans , Male , Parents/psychology , Psychometrics , Reproducibility of Results , Self ReportABSTRACT
Objective: To describe the cross-cultural adaptation of the Spence Children's Anxiety Scale (SCAS) for use in Brazil. Methods: Cross-cultural adaptation followed a four-step process, based on specialized literature: 1) investigation of conceptual and item equivalence; 2) translation and back-translation; 3) pretest; and 4) investigation of operational equivalence. All these procedures were carried out for both the child and the parent versions of the SCAS. Results: A final Brazilian version of the instrument, named SCAS-Brasil, was defined and is presented. Conclusion: The SCAS-Brasil instrument seems to be very similar to the original SCAS in terms of conceptual and item equivalence, semantics, and operational equivalence, suggesting that future cross-cultural studies may benefit from this early version. As a result, a new instrument is now available for the assessment of childhood anxiety symptoms in community, clinical, and research settings (AU)
Objetivo: Descrever a adaptação transcultural da Escala Spence de Ansiedade Infantil (Spence Children's Anxiety Scale, SCAS) para uso no Brasil. Método: O processo de adaptação transcultural seguiu um processo de quatro etapas baseado em literatura especializada: 1) investigação da equivalência conceitual e dos itens; 2) tradução e retrotradução; 3) pré-teste; e 4) investigação da equivalência operacional. Todos os procedimentos foram realizados tanto para a versão da criança quanto para a versão dos pais da SCAS. Resultados: Uma versão final brasileira do instrumento, denominada SCAS-Brasil, foi obtida e é apresentada. Conclusão: A SCAS-Brasil se mostra muito similar à versão original da SCAS no que diz respeito à equivalência conceitual e dos itens, semântica e equivalência operacional, sugerindo que futuros estudos transculturais poderiam se beneficiar desta primeira versão. Como resultado, um novo instrumento está agora disponível para a avaliação de sintomas de ansiedade na infância, em contextos comunitário, clínico e de pesquisa (AU)
Subject(s)
Humans , Child , Adolescent , Anxiety/diagnosis , Anxiety Disorders/diagnosis , Surveys and Questionnaires , Translations , Brazil , Cross-Cultural Comparison , Reproducibility of ResultsABSTRACT
OBJECTIVE: To describe the cross-cultural adaptation of the Spence Children's Anxiety Scale (SCAS) for use in Brazil. METHODS: Cross-cultural adaptation followed a four-step process, based on specialized literature: 1) investigation of conceptual and item equivalence; 2) translation and back-translation; 3) pretest; and 4) investigation of operational equivalence. All these procedures were carried out for both the child and the parent versions of the SCAS. RESULTS: A final Brazilian version of the instrument, named SCAS-Brasil, was defined and is presented. CONCLUSION: The SCAS-Brasil instrument seems to be very similar to the original SCAS in terms of conceptual and item equivalence, semantics, and operational equivalence, suggesting that future cross-cultural studies may benefit from this early version. As a result, a new instrument is now available for the assessment of childhood anxiety symptoms in community, clinical, and research settings.
