Applicability of a cognitive model and treatment to worry in children and adolescents
- Jacqui Rogers (Senior Lecturer)
Förlag: British Association for Behavioural and Cognitive Psychotherapy
Studies have found that the cognitive model of worry developed by Dugas, Gagnon, Ladouceur and Freeston (1998) involving Intolerance of Uncertainly (IU), Cognitive Avoidance (CA), Positive Beliefs about Worry (PB), and Negative Problem Orientation (NPO) accounts for approximately 40-50% of the variance in worry frequency in adults. A recent trial of the treatment based on this model (Dugas, Brillon, Savard et al., 2010) found it to be superior to no treatment and marginally superior to applied relaxation in adults with Generalized Anxiety Disorder (GAD). In this presentation the authors discuss the results of two studies testing the applicability of this cognitive model to children and adolescents. In the first study measures of IU, CA, PB, worry and anxiety were administered to 515 British primary and secondary school students (aged 7-19 years). A path analysis was undertaken to test whether IU acted as a higher order variable for CA and PB and whether the relationship between IU/CA/PB and anxiety was mediated by worry frequency. Significant (bivariate) correlations were observed between the measures of IU, PB, CA, worry and anxiety across the age range. However separate path models had to be fitted for children (aged 7-12 years) and adolescents (aged 13-19) with PB being dropped from the child model. CA was related to anxiety only through worry in children while IU showed direct paths to worry and anxiety in both children and adolescents. In the second study we present results from a case series where a modified version of the treatment based on the Dugas et al (1998) led to an 80% reduction in GAD diagnoses in 16 youth (aged 7-17 years) clinically referred for anxiety. Further testing and refinement of this cognitive model and its treatment may lead to further improvements in our understanding of worry in youth and its treatment. Possible modifications and refinements are discussed.