Coping Cat

Scientific Rating:
1
Well-Supported by Research Evidence
See scale of 1-5
Child Welfare System Relevance Level:
Medium
See descriptions of 3 levels

About This Program

The information in this program outline is provided by the program representative and edited by the CEBC staff. Coping Cat has been rated by the CEBC in the area of: Anxiety Treatment (Child & Adolescent).

Target Population: Children experiencing problematic levels of anxiety

For children/adolescents ages: 7 – 13

For parents/caregivers of children ages: 7 – 13

Brief Description

Coping Cat is a cognitive-behavioral treatment for children with anxiety. The program incorporates 4 components:

  • Recognizing and understanding emotional and physical reactions to anxiety
  • Clarifying thoughts and feelings in anxious situations
  • Developing plans for effective coping
  • Evaluating performance and giving self-reinforcement

Coping Cat also has a version for adolescents, ages 14-17, known as the C.A.T. Project which is highlighted on the CEBC as well.

Program Goals:

The overall goal of Coping Cat is:

  • Reduce anxiety

Essential Components

The essential components of the Coping Cat program include:

  • Psychoeducation, involving information for children and families about how anxiety can develop and be maintained, and how it can be treated
  • Exposure tasks, which give the child the chance to be in the feared situation and have a mastery experience
  • Somatic management, which teaches relaxation techniques
  • Cognitive restructuring which addresses FEAR: Feeling frightened, expecting bad things, attitudes and actions that will help, and results and rewards
  • Problem solving to generate and evaluate specific actions for dealing with problems
  • For group sessions, 4-5 participants per group is recommended

Child/Adolescent Services

Coping Cat directly provides services to children/adolescents and addresses the following:

  • Anxiety

Parent/Caregiver Services

Coping Cat directly provides services to parents/caregivers and addresses the following:

  • Parents are involved in the child-focused (individual treatment) program, and meet in sessions 4 and 9, as well as in other sessions as needed for the exposure tasks. There is also a family (parents included) treatment section.

Delivery Settings

This program is typically conducted in a(n):

  • Community Agency
  • Group Home
  • Hospital
  • Residential Care Facility
  • School

Homework

Coping Cat includes a homework component:

One STIC task (where STIC stands for "Show That I Can") is assigned per week.

Languages

Coping Cat has materials available in languages other than English:

Chinese, Hungarian, Japanese, Norwegian, Spanish

For information on which materials are available in these languages, please check on the program's website or contact the program representative (contact information is listed at the bottom of this page).

Resources Needed to Run Program

The typical resources for implementing the program are:

  • Child workbook
  • Therapist manual
  • Office space
  • Access to an internet-connected computer if using the computer-assisted program

Minimum Provider Qualifications

None have been set at this time.

Education and Training Resources

There is a manual that describes how to implement this program, and there is training available for this program.

Training Contact:
Training is obtained:

There are several training DVDs, including a computer-based training program (CBT4CBT) available at www.WorkbookPublishing.com

Number of days/hours:

The DVDs range in time from 40-90 minutes.

Implementation Information

Since Coping Cat is rated on the Scientific Rating Scale, information was requested from the program representative on available pre-implementation assessments, implementation tools, and/or fidelity measures.

Show implementation information...

Pre-Implementation Materials

There are no pre-implementation materials to measure organizational or provider readiness for Coping Cat.

Formal Support for Implementation

There is formal support available for implementation of Coping Cat as listed below:

Supervisory phone consultation is available.

Fidelity Measures

There are fidelity measures for Coping Cat as listed below:

The therapist manual describes session-by-session content. Each session’s description begins with the goals/targets for that session. When checking on fidelity, tapes of sessions are listened to in order to check that the goals/targets for the session were addressed. Although they require a person familiar with the model, there are forms that can be used to assess fidelity when listening to the session. The fidelity form also has places for the supervisor to rate the therapist on several dimensions. The form is not publicly available.

Implementation Guides or Manuals

There are implementation guides or manuals for Coping Cat as listed below:

Therapist treatment manual is available. It can be purchased at www.WorkbookPublishing.com.

Research on How to Implement the Program

Research has been conducted on how to implement Coping Cat as listed below:

  • Podell, J. L., Kendall, P. C., Gosch, E. A., Compton, S. N., March, J. S., Albano, A. M., ... & Piacentini, J. C. (2013). Therapist factors and outcomes in CBT for anxiety in youth. Professional Psychology: Research and Practice, 44(2), 89.
  • Schoenwald, S. K., Mehta, T. G., Frazier, S. L., & Shernoff, E. S. (2013). Clinical supervision in effectiveness and implementation research. Clinical Psychology: Science and Practice, 20(1), 44-59.

Relevant Published, Peer-Reviewed Research

This program is rated a "1 - Well-Supported by Research Evidence" on the Scientific Rating Scale based on the published, peer-reviewed research available. The program must have at least two rigorous randomized controlled trials with one showing a sustained effect of at least 1 year. The article(s) below that reports outcomes from an RCT showing a sustained effect of at least 1 year has an asterisk (*) at the beginning of its entry. Please see the Scientific Rating Scale for more information.

Child Welfare Outcome: Child/Family Well-Being

Show relevant research...

When more than 10 research articles have been published in peer-reviewed journals, the CEBC selects 10 for inclusion, with a preference for randomized controlled trials (RCTs) and controlled studies. The 10 articles chosen for Coping Cat are listed below:

*Kendall, P. C. (1994). Treating anxiety disorders in children: Results of a randomized clinical trial. Journal of Consulting and Clinical Psychology, 62(1), 100-110. doi:10.1037/0022-006X.62.1.100

Type of Study: Randomized controlled trial
Number of Participants: 47

Population:

  • Age — 9-13 years
  • Race/Ethnicity — Treatment: 78% White and 22% African American, Control: 76% White
  • Gender — 60% Male
  • Status — Participants were children with anxiety disorders who were referred by community sources.

Location/Institution: Philadelphia, PA

Summary: (To include comparison groups, outcomes, measures, notable limitations)
Children were randomly assigned to receive a cognitive-behavioral therapy [now called Coping Cat] or to a wait-list control group. Children were given self-report measures which included the Revised Children's Manifest Anxiety Scale (RCMAS), State-Trait Anxiety Inventory for Children (STAIC), the Fear Survey Schedule for Children, the Children’s Depression Inventory (CDI), and the Coping Questionnaire. Parents completed the Child Behavior Checklist (CBCL) and the State-Trait Anxiety Inventory for Adults (STAI) for parents. Interviews of children were also conducted using the Anxiety Disorders Interview Schedule for Children (ADIS-C). Analyses showed that over 60% of treated children had returned to within normal anxiety levels by the end of treatment and that this percentage was significantly greater than the control group. Treatment gains were maintained at one year. Limitations include a small sample size and an inability to rule out the children’s relationship with the therapist as a factor, since the waitlist participants received no treatment at the time of the study.

Length of postintervention follow-up: 1 year (intervention only).

*Kendall, P. C., & Southam-Gerow, M. A. (1996). Long-term follow-up of a cognitive-behavioral therapy for anxiety-disordered youth. Journal of Consulting and Clinical Psychology, 64(4), 724-730. doi:10.1037/0022-006X.64.4.724

Type of Study: Randomized controlled trial
Number of Participants: 36

Population:

  • Age — 11-18 years at follow-up
  • Race/Ethnicity — Not specified
  • Gender — 20 Males and 16 Females
  • Status — Participants were youth who had completed treatment for an anxiety disorder.

Location/Institution: Philadelphia, PA

Summary: (To include comparison groups, outcomes, measures, notable limitations)
Note: This study uses the same sample as Kendall (1994). Participants were clients who had completed cognitive-behavioral therapy for an anxiety disorder [now called Coping Cat] at least 2 years prior to this follow-up. Self-report assessments were mailed to participants and phone interviews were conducted with parents. Self-report measures included the Revised Children’s Manifest Anxiety Scale (RCMAS), the Coping Questionnaire, the Children’s Negative Affectivity Self-Statement Questionnaire, and the Children’s Depression Inventory (CDI). The parent interviews included the Child Behavior Checklist (CBCL), the State-Trait Anxiety Inventory (STAI) and parent versions of the Coping Questionnaire and the Anxiety Disorders Interview Schedule for Children (ADIS-C). Therapeutic gains were maintained according to measures of anxiety, self-reported anxious self-talk, and self-reported depression. The authors note that there was no control group for this analysis because the entire original wait-list group had received treatment.

Length of postintervention follow-up: 2-5 years(intervention only).

*Kendall, P. C., Flannery-Schroeder, E., Panichelli-Mindell, S. M., Southam-Gerow, M., Henin, A., & Warman, M. (1997). Therapy for youths with anxiety disorders: A second randomized clinical trial. Journal of Consulting and Clinical Psychology, 65(3), 366-380. doi:10.1037/0022-006X.65.3.366

Type of Study: Randomized controlled trial
Number of Participants: 94 children

Population:

  • Age — 9-13 years
  • Race/Ethnicity — 85% Caucasian, 5% African American, 2% Hispanic, 2% Asian, and 5% Other
  • Gender — 38% Female
  • Status — Participants were children referred from community sources with a diagnosis of primary anxiety disorder.

Location/Institution: Philadelphia, PA

Summary: (To include comparison groups, outcomes, measures, notable limitations)
Children were randomly assigned to receive cognitive-behavioral therapy [now called Coping Cat] or to an 8-week wait-list group. Anxiety was assessed with the Anxiety Disorders Interview Schedule for Children (ADIS-C). Child self-report measures included the Revised Children’s Manifest Anxiety Scales (RCMAS), the State Trait Anxiety Inventory for Children (STAIC), and the Coping Questionnaire. Parents completed the Child Behavior Checklist (CBCL) and the Coping Questionnaire for parents. Children were reassessed at posttreatment and at 1-year posttreatment. Results showed significant reductions in severity of anxiety at posttreatment, with over 50% of children scoring as free from their primary disorder. Gains were maintained at the 1-year follow-up. Limitations include small sample size, the waiting-list duration was not identical to the duration of treatment, and reliance on self-reported measures.

Length of postintervention follow-up: 1 year (intervention only).

*Kendall, P. C., Safford, S., Flannery-Schroeder, E., & Webb, A. (2004). Child anxiety treatment: Outcomes in adolescence and impact on substance abuse and depression at 7.4 year follow-up. Journal of Consulting and Clinical Psychology, 72(2), 276-287. doi:10.1007/s10608-005-3168-z

Type of Study: Randomized controlled trial
Number of Participants: 86

Population:

  • Age — 15-22 years
  • Race/Ethnicity — 86% Caucasian, 6% African American, 2% Latino, 2% Asian, and 4% Biracial
  • Gender — 35% Female
  • Status — Participants were youth referred from community sources and diagnosed with a primary anxiety disorder.

Location/Institution: Philadelphia, PA

Summary: (To include comparison groups, outcomes, measures, notable limitations)
Note: This study is a long-term follow-up of the sample used in Kendall et al., 1997. This report includes those participants originally randomly assigned to the Cognitive-Behavioral Therapy (CBT) condition (Coping Cat) and also wait-listed children who received Coping Cat after the conclusion of the initial study period. Anxiety measures for the long-term follow-up included the child and parent versions of the Anxiety Disorders Interview Schedule (ADIS), or the Lifetime version of the ADIS for those participants over 17. Youths’ self-report measures also included the Revised Children’s Manifest Anxiety Scale (RCMAS), the Children’s Depression Inventory (CDI), the Coping Questionnaire, and the Adolescent Perceived Events Scale, which assesses stressful events. Parents completed the Child Behavior Checklist (CBCL), the parent version of the Coping Questionnaire, and the State-Train Anxiety Inventory for Children (STAIC). Alcohol and drug use was assessed with the appropriate module of the Comprehensive Adolescent Severity Inventory (CASI). Results showed that the majority of participants maintained treatment gains with regard to anxiety. Those who had been successfully treated in the initial study also reported fewer problems with substance abuse in the long-term follow-up. Limitations include the lack of a comparison group and small sample size.

Length of postintervention follow-up: 5.5-9.3 years (intervention only).

*Flannery-Schroeder, E., Choudhury, M. Y., & Kendall, P. C. (2005). Group and individual cognitive-behavioral treatments for youth with anxiety disorders: 1-year follow-up. Cognitive Therapy and Research, 29(2), 253-259. doi:10.1007/s10608-005-3168-z

Type of Study: Randomized controlled trial
Number of Participants: 37

Population:

  • Age — 8-14 years
  • Race/Ethnicity — 11% Minority
  • Gender — 60% Male
  • Status — Participants were referred to a clinic for an anxiety disorder.

Location/Institution: Philadelphia, PA

Summary: (To include comparison groups, outcomes, measures, notable limitations)
Participants who had been randomly assigned to receive a group cognitive-behavioral therapy (GCBT), individual cognitive-behavioral therapy (ICBT) [now called Coping Cat], or to a waitlist control group (WL) were re-assessed at one year post-treatment using the Anxiety Disorders Interview Schedule for Children (ADIS-C). The children completed the Revised Children’s Manifest Anxiety Scale (RCMAS) and the children completed the State-Trait Anxiety Inventory for Children (STAIC) and their parents completed the State-Trait Anxiety Inventory (STAI). In addition, parents completed the Child Behavior Checklist (CBCL) and the Coping Questionnaire and teachers completed the Teacher Report Form (TRF). Results showed that 81% of ICBT and 77% of GCBT children had maintained treatment gains. Limitations include small sample size and reliance on self-reported measures.

Length of postintervention follow-up: 1 year (intervention only).

*Kendall, P. C., Hudson, J. L., Gosch, E., Flannery-Schroeder, E., & Suveg, C. (2008). Cognitive-behavioral therapy for anxiety disordered youth: A randomized clinical trial evaluating child and family modalities. Journal of Consulting and Clinical Psychology, 76(2), 282-297. doi:10.1037/0022-006X.76.2.282

Type of Study: Randomized controlled trial
Number of Participants: 161

Population:

  • Age — 7-14 years
  • Race/Ethnicity — 85% Caucasian, 9% African American, 3% Hispanic, and 3% other/mixed
  • Gender — 44% Female
  • Status — Participants were youth referred by community sources with a diagnosis of a principal anxiety disorder.

Location/Institution: Not specified

Summary: (To include comparison groups, outcomes, measures, notable limitations)
Participants were randomly assigned to individual cognitive-behavioral therapy (ICBT) for anxious children [now called Coping Cat], Family Cognitive Behavioral Therapy (FCBT) with some Coping Cat components, or to a family-based education, support, and attention (FESA) comparison group. Children’s anxiety was measured using a semi-structured interview (the Anxiety Disorders Interview Schedule for Children (ADIS-C/P)) and two self-report measures, the Multidimensional Anxiety Scale for Children (MASC) and the Coping Questionnaire-Child (CQ-C). Parent and teacher reports of child functioning were also collected using the Child Behavior Checklist (CBCL), the Teacher Report Form (TRF), and the Coping Questionnaire-Parent (CQ-P). Results showed that children in the ICBT and FCBT conditions improved significantly more than those in the FESA condition, although all groups improved over baseline. Improvements were maintained at one year. Children whose parents also had an anxiety disorder showed greater improvement in the FESA condition. Limitations include relatively small sample size and reliance on self-reported measures.

Length of postintervention follow-up: 1 year.

Walkup, J. T., Albano, A. M., Piacentini, J., Birmaher, B., Compton, S. N., Sherrill, J. T., ... & Kendall, P. C. (2008). Cognitive behavioral therapy, sertraline, or a combination in childhood anxiety. The New England Journal of Medicine, 359(26), 2753-2766. doi:10.1056/NEJMoa0804633

Type of Study: Randomized controlled trial
Number of Participants: 488 children

Population:

  • Age — 7-17 years.
  • Race/Ethnicity — 78.9% White, 12.1% Hispanic, 9.0% Black, 2.5% Asian, 1.2% American Indian, 0.4% Pacific Islander, and 8.0% Other
  • Gender — 49.6% Female
  • Status — Participants were children with a primary diagnosis of separation or generalized anxiety disorder or social phobia.

Location/Institution: United States

Summary: (To include comparison groups, outcomes, measures, notable limitations)
Children were randomly assigned to receive Coping Cat, sertraline (Zoloft) alone, a combination of Coping Cat plus Zoloft, or a placebo. Outcomes were assessed at baseline, 4, 8, and 12 weeks using the Clinical Global Impression Improvement Scale (CGII) and the Pediatric Anxiety Rating Scale. All therapies were better than the placebo, with the percentages of children rated as very much or much improved 80.7% for the combined therapy, 59.7% for Coping Cat, and 54.9% for Zoloft alone, compared with 23.7% for the placebo group. Limitations include a lack of children in the lowest socioeconomic groups and exclusion of children with other diagnoses such as depression.

Length of postintervention follow-up: None.

Ginsburg, G., Becker, E., Keeton, C., Sakolsky, D., Piacentini, J., Albano, A. M., … Kendall, P. C. (2014). Naturalistic follow-up of youths treated for pediatric anxiety disorders. Journal of the American Medical Association Psychiatry (JAMA Psychiatry), 71, 310-318. doi:10.1001/jamapsychiatry.2013.4186

Type of Study: Randomized controlled trial
Number of Participants: 288

Population:

  • Age — 11-26 years (Mean=17 years)
  • Race/Ethnicity — 81.6% White, 8.7% African American, 3.1% Asian, 8% Hispanic and 6.6% Other
  • Gender — 160 Females
  • Status — Participants were children with a primary diagnosis of separation or generalized anxiety disorder or social phobia.

Location/Institution: Not specified

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This study utilizes information from Walkup et al. (2008) to determine whether acute clinical improvement and treatment type (e.g., Coping Cat, medication, or their combination) predicted remission of anxiety and improvement in global functioning at a mean of 6 years after randomization and to examine predictors of outcomes at follow-up. Youths were randomized to 1 of 4 interventions (Coping CAT, medication, combination, or pill placebo) in the Child/Adolescent Anxiety Multimodal Study. Measures utilized include the Clinical Global Impression–Severity scale, the Children’s Global Assessment Scale, the Brief Family Assessment Measure, the Brief Symptom Inventory, the State-Trait Anxiety Inventory–Trait, the Anxiety Disorders Interview Schedule Supplemental Services Form, and the Life Events Scale. Results indicate that almost half of the sample (46.5%) was in remission at follow-up. Responders to acute treatment were significantly more likely to be in remission at follow-up and had less severe anxiety symptoms and higher functioning. The assigned treatment arm was unrelated to outcomes. Limitations include the attrition rate of the original study sample at the follow-up time point, the naturalistic nature of the follow-up study (as other treatments may have occurred), and the generalizability of the findings (particularly to male youths and youths from nonwhite and lower-socioeconomic status backgrounds).

Length of postintervention follow-up: 4-9 years with a mean of 6 years.

Kendall, P. C., Cummings, C. M., Villabø, M. A., Narayanan, M. K., Treadwell, K., Birmaher, B., ... & Gosch, E. (2016). Mediators of change in the Child/Adolescent Anxiety Multimodal Treatment Study. Journal of Consulting and Clinical Psychology, 84(1), 1-14. doi:10.1037/a0039773

Type of Study: Randomized controlled trial
Number of Participants: 488

Population:

  • Age — 7-17 years
  • Race/Ethnicity — 78.9% White, 12.1% Hispanic, 9.0% Black, 2.5% Asian, 1.2% American Indian, 0.4% Pacific Islander, and 8.0% Other
  • Gender — 49.6% Female
  • Status — Participants were children with a primary diagnosis of separation or generalized anxiety disorder or social phobia.

Location/Institution: United States

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This study utilizes information from Walkup et al. (2008) to evaluate (a) anxious self-talk and (b) coping efficacy as potential mediators in Child/Adolescent Anxiety Multimodal Treatment Study (CAMS). Youths were randomized to 1 of 4 interventions (Coping Cat, medication, combination, and placebo) in the Child/Adolescent Anxiety Multimodal Study. Measures utilized include the Coping Questionnaire, Parent and Child/Youth Versions (CQ-C/P), the Negative Affectivity Self-Statement Questionnaire (NASSQ), the Anxiety Disorders Interview Schedule-Child/Parent Versions (ADIS-IV-C/P), and the Pediatric Anxiety Rating Scale (PARS). Results indicate that residualized gains in coping efficacy mediated gains in the Coping Cat, sertraline, and combination conditions. In the combination condition, some unique effect of treatment remained. Treatment assignment was not associated with a reduction in anxious self-talk, nor did anxious self-talk predict changes in anxiety symptoms. Limitations include the attrition rate of the original study sample at the follow-up time point, additional services or medication during the follow-up period was not controlled, and the generalizability of the findings (particularly to male youths and youths from nonwhite and lower-SES backgrounds).

Length of postintervention follow-up: 3 months.

Silk, J. S., Tan, P. Z., Ladouceur, C. D., Meller, S., Siegle, G. J., McMakin, D. L., ... Ryan, N. D. (2016). A randomized clinical trial comparing individual cognitive behavioral therapy and child-centered therapy for child anxiety disorders. Journal of Clinical Child & Adolescent Psychology. Advance online publication. doi:10.1080/15374416.2016.1138408

Type of Study: Randomized controlled trial
Number of Participants: 133

Population:

  • Age — 9-14 years
  • Race/Ethnicity — 89% Caucasian, 4% African-American, 2% Hispanic, and 5% Biracial
  • Gender — 56% Female
  • Status — Participants were children with a primary diagnosis of generalized anxiety disorder.

Location/Institution: United States

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This study compared individual Coping Cat (CBT) and child-centered therapy (CCT) for child anxiety disorders on rates of treatment response and recovery at post-treatment and one-year follow-up, as well as on real-world measures of emotional functioning. Youths were randomized to Coping Cat or CCT. Measures utilized include the Wechsler Abbreviated Scale of Intelligence, the Schedule for Affective Disorders and Schizophrenia in School-Age Children—Present and Lifetime version (K-SADS-PL), the Pediatric Anxiety Rating Scale (PARS) and the Positive and Negative Affect Scale for Children (PANAS-C). Results indicate that the majority of youth in both Coping CAT (CBT) and CCT were classified as treatment responders, but youth treated with Coping Cat were significantly more likely to fully recover, no longer meeting diagnostic criteria for any of the targeted anxiety disorders, and no longer show residual symptoms. Youth treated with Coping Cat also reported significantly lower negative emotions associated with recent negative events experienced in daily life during the latter stages of treatment relative to youth treated with CCT. Furthermore, a significantly higher percentage of youth treated with Coping Cat compared to CCT were in recovery at one-year follow-up. Limitations include findings may not generalize to treatments combined with medication, high attrition rate, and sample was primarily Caucasian and middle class limiting generalization to more diverse samples.

Length of postintervention follow-up: 1 year.

References

Kendall, P. C., & Hedtke, K. (2006). Cognitive-behavioral therapy for anxious children: Therapist manual (3rd ed.). Ardmore, PA: Workbook Publishing.

Kendall, P. C., & Hedtke, K. (2006). Coping Cat workbook. (2nd ed). Ardmore, PA: Workbook Publishing.

Khanna, M., & Kendall, P. C. (2008).  Computer assisted CBT for child anxiety: The Coping Cat CD-ROM.  Cognitive and Behavioral Practice, 15, 159-165.

Contact Information

Name: Philip C. Kendall, PhD, ABPP
Agency/Affiliation: Temple University
Website: www.workbookpublishing.com
Email:
Phone: (215) 204-7165
Fax: (215) 204-0565

Date Research Evidence Last Reviewed by CEBC: August 2016

Date Program Content Last Reviewed by Program Staff: March 2016

Date Program Originally Loaded onto CEBC: May 2009