Building Confidence
About This Program
Target Population: Typically developing school-aged children diagnosed with childhood anxiety disorders (6-11 years old) and their families
For children/adolescents ages: 6 – 11
Program Overview
Building Confidence is a cognitive-behavioral therapy (CBT) that is provided to school-aged children who demonstrate clinically significant symptoms of a range of anxiety disorders (e.g., separation anxiety disorder). The format consists of individual child therapy combined with parent-training and involvement. Both children and their parents are taught fundamental CBT principles and techniques as well as integrating ways to build confidence through graduated learning and practice of age-appropriate self-independence skills. In-session exposures are extended into the home where parents assist children complete home-based exposures in the community by providing coaching in CBT strategies and naturalistic opportunities to practice and maintain treatment goals and effects. In line with these overarching treatment goals, the intervention program also works closely with the children's schools and teachers to promote the practice and generalization of treatment goals in the school (e.g., social anxiety).
Program Goals
The goal of Building Confidence is:
- Enhance the learning and maintenance of treatment strategies via child and parent involvement in treatment
Logic Model
The program representative did not provide information about a Logic Model for Building Confidence.
Essential Components
The essential components of Building Confidence include:
- Assessment of anxiety and age-appropriate self-help skill milestones
- Development hierarchy to gradually help child build confidence to anxiety provoking situations (including areas of self-help) and obtaining child/parent ratings
- Developing in-session and home-based exposure tasks that are implemented in real-word settings (i.e., not based only within the therapy setting)
- Providing psychoeducation to parents and training on CBT strategies for parents to "coach" children to develop confidence and manage anxiety symptoms
- Developing close partnerships and collaborative working relationship with school and key personnel (e.g., teachers) to bridge the gap between clinic, home, and school goals and provide real-life opportunities to build confidence and success with CBT skills and anxiety management (e.g., teacher provides opportunities for skills being learned in treatment and provides additional monitoring of acquisition and maintenance of skills)
- The use of humor and rewards to build skills and develop positive and meaningful experiences in which they are confident and successfully manage anxiety symptoms
Program Delivery
Child/Adolescent Services
Building Confidence directly provides services to children/adolescents and addresses the following:
- Childhood anxiety disorders—specifically, separation anxiety disorder, social anxiety, obsessive-compulsive disorder, and generalized anxiety disorder
Services Involve Family/Support Structures:
This program involves the family or other support systems in the individual's treatment: Parents are provided with psychoeducation about anxiety, independence skills, and CBT strategies to both help coach children during home-based exposures and provided opportunities to target treatment goals with the natural setting of the home, community, etc. The school system is also elicited as a support system so that key school personnel (e.g., teachers) can provide opportunities for treatment goals and monitoring of the child with the school environment.
Recommended Intensity:
Weekly 1.5-hour session
Recommended Duration:
16 weeks
Delivery Settings
This program is typically conducted in a(n):
- Community Daily Living Setting
- Outpatient Clinic
- School Setting (Including: Day Care, Day Treatment Programs, etc.)
Homework
Building Confidence includes a homework component:
Homework is given at weekly sessions.
Resources Needed to Run Program
The typical resources for implementing the program are:
Clinicians, confederates (e.g., university students or other staff who can serve as confederates for exposure activities), access to local community settings (e.g., restaurants or stores), access to a telephone (for exposures requiring phone calls), treatment room and waiting area, assistants to supervise or watch the child while therapist conducts the parent portion of the treatment session, child appropriate games or toys, child appropriate rewards (e.g., edibles, stickers), tape recorder to record sessions, paper and writing materials to create homework sheets or session materials.
Manuals and Training
Prerequisite/Minimum Provider Qualifications
Experience working in clinical setting with children and families; experience with cognitive-behavioral interventions; and at least a Master's level clinical training experience.
Manual Information
There is a manual that describes how to deliver this program.
Training Information
There is training available for this program.
Training Type/Location:
Provided in Los Angeles or remotely (online)
Number of days/hours:
4-6 hours
Implementation Information
Pre-Implementation Materials
There are no pre-implementation materials to measure organizational or provider readiness for Building Confidence.
Formal Support for Implementation
There is no formal support available for implementation of Building Confidence.
Fidelity Measures
There are fidelity measures for Building Confidence as listed below:
There is an observational checklist that is used based on video or audiotape review of a therapist's sessions. It is available upon request from the program representative whose information is at the end of this entry.
Implementation Guides or Manuals
There are implementation guides or manuals for Building Confidence as listed below:
There is a manual: Wood, J. J., & McLeod, B. D. (2008). Child anxiety disorders: A family-based treatment manual for practitioners. W. W. Norton & Co.
Research on How to Implement the Program
Research has not been conducted on how to implement Building Confidence.
Relevant Published, Peer-Reviewed Research
Child Welfare Outcome: Child/Family Well-Being
Wood, J. J., Piacentini, J. C., Southam-Gerow, M., Chu, B. C., & Sigman, M. (2006). Family cognitive behavioral therapy for child anxiety disorders. Journal of the American Academy of Child & Adolescent Psychiatry, 45(3), 314-321. https://doi.org/10.1097/01.chi.0000196425.88341.b0
Type of Study:
Randomized controlled trial
Number of Participants:
40
Population:
- Age — 6-13 years
- Race/Ethnicity — 24 Caucasian, 4 Hispanic, 1 African American, 1 Asian/Pacific Islander, and 9 other
- Gender — 24 Males and 16 Females
- Status — Participants were parents and children with anxiety disorders from a major metropolitan area of the western United States referred through school psychologists, principals, and a child anxiety clinic.
Location/Institution: University of California, Los Angeles
Summary:
(To include basic study design, measures, results, and notable limitations)
Parents and children were randomly assigned to one of two treatment groups: family-focused cognitive behavioral therapy (the Building Confidence Program) or traditional child-focused CBT with minimal family involvement for children with anxiety disorders. The Building Confidence Program group received parent communication training. Measures used included the Anxiety Disorders Interview Schedule (ADIS-CP), Clinical Global Impressions Improvement Scale (CGI), and the Multidimensional Anxiety Scale for Children (MASC). Follow-up assessments occurred in the middle of treatment for self-report and parent-report measures only, and at posttreatment for all measures. Results indicated that parent reports and independent evaluator ratings suggest that, when compared with an individual child-focused treatment, Building Confidence Program produced greater symptom reduction and improved functioning at posttreatment. Limitations included the lack of post-intervention follow-up.
Length of controlled postintervention follow-up: None.
Wood, J. J., McLeod, B. D., Piacentini, J. C., & Sigman, M. (2009). One-year follow-up of family versus child CBT for anxiety disorders: Exploring the roles of child age and parental intrusiveness. Child Psychiatry and Human Development, 40(2), 301-316. https://doi.org/10.1007/s10578-009-0127-z
Type of Study:
Randomized controlled trial
Number of Participants:
35
Population:
- Age — 6-13 years
- Race/Ethnicity — 69% Caucasian, 21% Multiracial, 3% Hispanic, 3% African American, and 3% Asian
- Gender — 66% Male and 34% Female
- Status — Participants were parents and children with anxiety disorders who participated in the 2006 Wood et al. study.
Location/Institution: University of California, Los Angeles
Summary:
(To include basic study design, measures, results, and notable limitations)
This study is a follow-up of the Wood et al. (2006) study summarized above. This study compared the relative long-term benefit of family-focused cognitive behavioral therapy (FCBT; Building Confidence Program) and child-focused cognitive behavioral therapy (CCBT) for child anxiety disorders. Parents and children completed the Anxiety Disorders Interview Schedule (ADIS-CP), Clinical Global Impressions Improvement Scale (CGI), Multidimensional Anxiety Scale for Children (MASC), and the Child Behavior Checklist (CBCL). Results indicated that children assigned to Building Confidence Program had lower anxiety scores than children assigned to CCBT on follow-up diagnostician- and parent-report scores, but not child-report scores, and that Building Confidence Program may yield a stronger treatment effect than CCBT that lasts for at least 1 year.
Length of controlled postintervention follow-up: 1 year.
Chiu, A. W., McLeod, B. D., Har, K., & Wood, J. J. (2009). Child–therapist alliance and clinical outcomes in cognitive behavioral therapy for child anxiety disorders. Journal of Child Psychology and Psychiatry, 50(6), 751-758. https://doi.org/10.1111/j.1469-7610.2008.01996.x
Type of Study:
Randomized controlled trial
Number of Participants:
34
Population:
- Age — 6-13 years
- Race/Ethnicity — 62% Caucasian, 6% Latino, 26% Multiracial, 3% Asian, and 3% African American
- Gender — 24 Males and 10 Females
- Status — Participants were parents and children with anxiety disorders who participated in the Wood et al. (2006) study.
Location/Institution: University of California, Los Angeles
Summary:
(To include basic study design, measures, results, and notable limitations)
This study used the same sample as the Wood et al. (2006) study (summarized above) to examine the nature and strength of the alliance–outcome association in CBT for child anxiety. Families were randomly assigned to Building Confidence Program or child-focused cognitive behavioral therapy (CCBT). The CCBT and Building Confidence Program conditions did not differ in treatment dosage or fidelity. The Therapy Process Observational Coding System for Child Psychotherapy – Alliance Scale (TPOCS-A) was used to measure the quality of the child alliance and coders independently rated 123 CBT therapy sessions. Results indicated that a stronger child–therapist alliance early in treatment predicted greater improvement in parent-reported outcomes at mid-treatment but not post-treatment. However, improvement in the child–therapist alliance over the course of treatment predicted better post-treatment outcomes. Limitations included lack of child-reported measures as well as small sample size.
Length of controlled postintervention follow-up: None.
The following studies were not included in rating Building Confidence on the Scientific Rating Scale...
Chiu, A. W., Langer, D. A., McLeod, B. D., Har, K., Drahota, A., Galla, B. M., Jacobs, J., Ifekwunigwe, M., & Wood, J. J. (2013). Effectiveness of modular CBT for child anxiety in elementary schools. School Psychology Quarterly, 28(2), 141-153. https://doi.org/10.1037/spq0000017
This study evaluated a modular version of the Building Confidence program for childhood anxiety disorders in two elementary schools. Children with anxiety disorders, referred by teachers and school staff, were randomly assigned to Building Confidence or a 3-month waitlist. Measures included the Anxiety Disorders Interview Schedule for DSM–IV: Child and Parent Versions (ADISC/P), The Clinical Global Impressions (CGI)–Improvement Scale, the Multidimensional Anxiety Scale for Children (MASC), and the Child Behavior Checklist (CBCL). Results indicate children who received Building Confidence experienced greater caregiver reported anxiety symptom reduction, and marginally greater child reported anxiety symptom reduction, compared with children in the waitlist condition. Building Confidence children were also most likely to be anxiety diagnosis-free according to evaluators' ratings at posttreatment and postwaitlist. Limitations include the small sample size, the lack of an active treatment control group, and the lack of assessment of functioning as an outcome. Note: Due to the modifications made to the Building Confidence program, this study will not be used in the rating of the program.
Additional References
No reference materials are currently available for Building Confidence.
Contact Information
- Jeffrey James Wood
- Email: jwood@gseis.ucla.edu
Date Research Evidence Last Reviewed by CEBC: January 2021
Date Program Content Last Reviewed by Program Staff: April 2014
Date Program Originally Loaded onto CEBC: April 2011
