Cognitive-Behavioral Therapy

It has been estimated that 10-20% of children suffer from anxiety-related problems/symptoms at any one time and that anxiety disorders are among the most common problems affecting children and adolescents (Kendall, Chu, Pimentel, & Choudhury, 2000). By definition, anxiety symptoms can interfere with children’s daily functioning: to receive a diagnosis, the DSM-IV states that the symptoms must cause the child clinically significant distress or impairment in social, academic or other important areas of functioning.

Decades ago, researchers reported an association between high levels of self-reported anxiety and poor academic performance in samples of school children (Sarason et al. , 1960). More recently researchers have also found that anxiety symptoms and disorders lead to poor academic performance (Last, Hanson & Franco, 1997). Moreover, research findings suggest children and adolescents with anxiety problems are at increased risk of underachieving in school, dropping out of school, and/or not pursuing higher education compared to the general population (Van Ameringen et al.

, 2003). There has also been some evidence to indicate that the correlation between anxiety and academic performance becomes stronger as the student progresses through school (Sarason et al. , 1960). Ialongo et al. (1994) found that first grade children’s self report of anxiety symptoms was associated with poor academic performance. For instance, children with high anxiety were 7. 7 times more likely to be in the lowest quartile of math achievement. Similarly, children with high anxiety were 2. 4 times more likely to be in the lowest quartile of reading achievement.

One possible interpretation of this relationship is that the anxiety interferes with the individual’s academic performance. High levels of anxiety in children are likely to interfere with the child’s ability to concentrate and participate in class. As a result, the children’s academic achievement is likely to be negatively affected. Sarason and Sarason (1987) reported that cognitive interference plays a pivotal role in poor performance. According to Sarason and Sarason test anxious individuals become preoccupied with worry, insecurity and self-doubt in situations in which they are evaluated.

It is these “internal distractions” that decrease the individual’s attention to the task, thereby leading to poor performance. Comunian (1993) found that cognitive interference is positively associated with test anxiety and they are both negatively associated with school performance. Overall, the research to date on cognitive interference suggests that individuals with high anxiety (particularly test anxiety) tend to experience cognitive interference (intrusive thoughts). Cognitive interference during test situations may explain the poor academic performance demonstrated by individuals with high anxiety.

If left untreated, it is likely that the anxiety disorder and the decreased academic performance will worsen with time. Overall, the research to date postulates that an anxiety disorder can be debilitating to an individual by interfering with academic performance and thus leading to a decrease in self-esteem. Cognitive-behavioral therapy and psychoeducational therapy have been successful in reducing anxiety in children with anxiety disorders (Kendall et al. , 1997). Therefore, this paper aims to investigate whether cognitive-behavioral therapy effective for children with an anxiety disorder.

Definition and Description of Anxiety Anxiety is an individual’s response to a threatening situation or an event that may manifest as physiological symptoms (heart palpitations, sweating, trembling, etc. ), excessive worry, increased arousal, uneasiness, negative affect, tense apprehensiveness, and anticipation of a threatening event (Howard & Kendall, 1996). There has been a debate over whether anxiety is a result of a state or a trait. State anxiety refers to a temporary “state” of anxiety (i. e. test anxiety, performance anxiety); it is specific to a situation.

Trait anxiety refers to anxiety that is generalized across multiple settings. An individual who possess trait anxiety is anxious all the time and in any situation (Casado & Dereshiwsky, 2001). The DSM-IV (APA, 2000) describes Separation Anxiety Disorder as when a child displays excessive distress when separating from the caregiver or from home. The anxiety is abnormal for the individual’s developmental level. The onset is before age 18, occurs for at least 4 weeks and causes significant impairment in social, academic, or other areas of functioning. The separation anxious child may develop psychosomatic symptoms (i.

e. stomachache, headache, etc. ) when the separation takes place. A separation anxious child may worry about the thought of separating from his/her parents or from home. This child may exhibit temper tantrums when forced to separate from his/her parents or from home. The prevalence of Separation Anxiety Disorder (SAD) is about 4%. In clinical samples, SAD occurs equally in males and females (APA, 2000). The DSM-IV (APA, 2000) defines Generalized Anxiety Disorder (GAD) as excessive worry for more days than not for at least 6 months about a number of events or activities.

The individual with GAD has a very difficult time controlling the worry. The anxiety and worry tend to come with three additional symptoms of the following: restlessness, easily fatigued, difficulty concentrating, irritability, muscle tension, and sleeping problems. The frequency and duration of the anxiety is excessive and exaggerated. The child may worry that a specific event will happen even though the chances of that happening are one in a million. For example, the child may wonder “What if a robber breaks into my house at night while I am sleeping? Or. “What if a plane crashes into my house?

” Epidemiological studies report a lifetime prevalence of 5%. Women are diagnosed with GAD more frequently than men. In clinical settings, females are diagnosed with GAD 55%-60% more than men (APA, 2000). The DSM-IV (APA, 2000) defines Social Phobia (Social Anxiety Disorder) as persistent fear of one or more social or performance situations in which the individual is exposed to unfamiliar people or criticism of others. Exposure to the social or performance situation leads to an anxiety response. The feared situation is generally avoided or the individual endures it with excessive anxiety.

The individual’s fear is excessive or unrealistic. The individual with social phobia fears that he/she will humiliate himself or herself in front of other people. This excessive fear may lead to the child avoiding to raise his/her hand in class, participating in a school play, or initiating a conversation with his/her peers. Epidemiological studies report a lifetime prevalence of social phobia from 3%-13% (APA, 2000). It has also been reported that 10%-20% of individuals diagnosed with an anxiety disorder were diagnosed with Social Phobia (APA, 2000).

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