Rapee, R. M., Abbott, M. J., & Lyneham, H. J. (2006). Bibliotherapy for children with anxiety disorders using written materials for parents: A randomized controlled trial. Journal of Consulting and Clinical Psychology, 74(3), 436–444. https://doi.org/10.1037/0022-006X.74.3.436

Type of Study: Randomized controlled trial
Number of Participants: 267

Population:

• Age — 6–12 years
• Race/Ethnicity — Not specified
• Gender — Group Treatment: 53% Female; Bibliotherapy Group: 36% Female; Waitlist: 30% Female
• Status — Participants were children diagnosed with anxiety disorders who were referred by school counselors, general practitioners, or mental health professionals.

Location/Institution: Not specified

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to examine the impact of a 12-week trial of bibliotherapy materials based on the Cool Kids program for parents of children with anxiety disorders. Participants were randomized to one of three groups: Group treatment Cool Kids, bibliotherapy [now called Cool Kids Anxiety Program – Low Intensity Format], or to a waitlist condition group who were later randomized to one of the interventions. Measures utilized include the Anxiety Disorders Interview Schedule for Children and Parents (ADIS-CP), Spence Children’s Anxiety Scale (SCAS), Children’s Automatic Thoughts Scale (CATS), SCASp surveys, and the Child Behavior Checklist (CBCL). Results indicate that bibliotherapy demonstrated benefit for children relative to waitlist but was not as efficacious as the standard Cool Kids group treatment. Relative to waitlist, use of written materials for parents with no therapist contact resulted in around 15% more children being free of an anxiety disorder diagnosis after 12 and 24 weeks. Children in all three groups reported significant and marked change over time, but differences between groups were not significant. Limitations include reliance on semistructured interviews and parent-completed questionnaires as outcome measures and length of follow-up.

Length of controlled postintervention follow-up: 3 months.

Lyneham, H. J., & Rapee, R. M. (2006). Evaluation of therapist-supported parent-implemented CBT for anxiety disorders in rural children. Behaviour Research and Therapy, 44(9), 1287–1300. https://doi.org/10.1016/j.brat.2005.09.009

Type of Study: Randomized controlled trial
Number of Participants: 100

Population:

• Age — 6–12 years
• Race/Ethnicity — 90% Australian, 6% European, 3% Other, and 1% Asian
• Gender — 51% Male and 49% Female
• Status — Participants were self-referred parents and their children with anxiety disorders from rural communities.

Location/Institution: Macquarie University Anxiety Research Unit

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to examine the efficacy of bibliotherapy [now called Cool Kids Anxiety Program – Low Intensity Format], where a program is implemented solely through the use of written or computerized materials with little or no therapist contact, in a rural population. Participants were randomized to either 1) scheduled telephone sessions, 2) scheduled emails, 3) as-needed client-initiated contact, or 4) a wait-list control group. All groups were supplemented with bibliotherapy. Measures utilized include the Anxiety Disorders Interview Schedule for Children (ADIS-C-IV), the self-reported Spence Children’s Anxiety Scale (SCAS), Revised Children’s Manifest Anxiety Scale (RCMAS), Children’s Depression Inventory (CDI), Children’s Automatic Thoughts Scale (CATS), Child Behavior Checklist (CBCL), Parenting Stress Index (PSI), and the Depression Anxiety Stress Scale (DASS). Results indicate that bibliotherapy with any form of contact produced superior outcomes in comparison to no treatment on self-report measures and the clinician rated severity and diagnostic profile. Additionally, supplementing bibliotherapy with scheduled telephone sessions produced superior diagnostic outcomes and lower clinician-rated severity at post-treatment in comparison to email and client-initiated contact. Limitations include the lack of a ‘‘pure’’ bibliotherapy condition, the low number of families who satisfactorily implemented the program in the email and client-initiated conditions, and the lack of untreated control/comparison groups able to be evaluated at follow-up.

Length of controlled postintervention follow-up: None.

McLoone, J. K., & Rapee, R. M. (2012). Comparison of an anxiety management program for children implemented at home and school: Lessons learned. School Mental Health: A Multidisciplinary Research and Practice Journal, 4(4), 231–242. https://doi.org/10.1007/s12310-012-9088-7

Type of Study: Randomized controlled trial
Number of Participants: 152

Population:

• Age — Children: 8–13 years (Mean=9.63–9.77 years); Parents: Mean=40–43 years
• Race/Ethnicity — Not specified
• Gender — Treatment Group: Children: 39% Male; Parents: Not specified
• Status — Participants were parents and their children in grades 2 through 6.

Location/Institution: 11 schools located within metropolitan Sydney, Australia

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to evaluate the feasibility of the Cool Kids program [now called Cool Kids Anxiety Program – Low Intensity Format] in the school- and home setting. Participants were randomly assigned to either a home-based treatment (parents provided with the manual for the Cool Kids program), the Cool Kids program, or monitoring only (wait list control). Measures utilized include the Spence Children’s Anxiety Scale (SCAS), Children’s Automatic Thoughts Scale (CATS), Spence Children’s Anxiety Scale-parent version (SCASp), Child Anxiety Life Interference Scale (CALIS), the Depression, Anxiety Stress Scales (DASS), the Barriers to Treatment Participation Scale, the School Anxiety Scale (SAS), and the Strengths and Difficulties Questionnaire (SDQ). Results of the study do not clearly indicate whether either of these approaches was effective in the treatment of child anxiety due to the apparent conflicting reports from different informants. Although parents of children receiving active treatment reported at postintervention significant decreases in their child’s anxiety relative to the waitlist control condition, children and teachers reported no significant differences between conditions. Limitations include the reliance on self-reported measures, concerns about lack of generalizability to other populations, and the high attrition rate.

Length of controlled postintervention follow-up: 12 months.

Chavira, D. A., Bustos, C., Garcia, M., Reinosa Segovia, F., Baig, A., Ng, B., & Camacho, A. (2018). Telephone-assisted, parent-mediated CBT for rural Latino youth with anxiety: A feasibility trial. Cultural Diversity and Ethnic Minority Psychology, 24(3), 429–441. https://doi.org/10.1037/cdp0000186

Type of Study: Randomized controlled trial
Number of Participants: 31

Population:

• Age — 8–13 years
• Race/Ethnicity — 100% Latino/Latina
• Gender — 29 Female
• Status — Participants were children with anxiety disorders recruited from primary care settings.

Location/Institution: A rural county in California by the United States Mexico Border

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to evaluate the feasibility, acceptability, tolerability, and safety of the Cool Kids Outreach Program [now called Cool Kids Anxiety Program – Low Intensity Format] modified for use with rural Latino/a Spanish-speaking families. Participants were randomly assigned to either 1 of 2 modes of parent-mediated CBT bibliotherapy: (1) telephone-delivered, therapist-assisted bibliotherapy (TTB), or (2) a more minimal contact, self-directed, bibliotherapy condition (SB). Modifications were mostly focused on improving the acceptability of the intervention and included mostly surface-level modifications such as translation of study materials, tailoring of examples to be culturally appropriate to Latino/a families and to the rural context, simplifying workbook materials, and addressing issues of literacy. Measures utilized include the Anxiety Disorders Interview Schedule for Children (ADIS-C-IV), Spence Children’s Anxiety Scale (SCAS), Adolescent Life Interference Scale (ALIS), Preferences and Attitudes Questionnaire, Children’s Automatic Thoughts Scale (CATS), and The Acculturation Rating Scale for Mexican Americans-II. Results indicate that in the TTB group, 10 of 15 parents (66.7%) completed the requisite number of therapist-assisted bibliotherapy sessions, and in the SB group, 4 of 16 parents (25%) completed the requisite number of self-directed bibliotherapy modules; this comparison was significant. In the TTB condition, treatment length and session duration were longer than reported in previous studies. Barriers that were most strongly endorsed were stressors and obstacles competing with treatment, as well as treatment demandingness. Findings revealed good satisfaction across the conditions, although ratings were significantly higher in the TTB group. Remission rates (i.e., no anxiety disorder) for those that provided posttreatment data were 50% and 36% for the TTB and SB groups respectively. Limitations include the small sample size, lack of a no treatment control group, lack of generalizability to other populations due to ethnicity and gender, and lack of follow-up.

Length of controlled postintervention follow-up: None.