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: 53.3% Female, Bibliotherapy Group: 35.6% Female, and Waitlist Group: 29.9% 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 study examined the impact of a 12-week trial of bibliotherapy materials based on the Cool Kids anxiety 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 Outreach], and to waitlist. Children completed the following measures at baseline, posttreatment, and 3-month follow-up: the Anxiety Disorders Interview Schedule for Children and Parents (ADIS-CP), Spence Children's Anxiety Scale (SCAS), Children's Automatic Thoughts Scale (CATS), and parents completed the parent version of the SCAS and the Child Behavior Checklist (CBCL). Results indicated that the 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 included 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, 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 — 96% Caucasian, 1% Asian, and 3% Other
• Gender — 51% Male and 49% Female
• Status — Participants were self-referred parents and 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 study examined the efficacy of bibliotherapy, where a program [now called Cool Kids Outreach] is implemented solely through the use of written or computerized materials with little or no therapist contact, in a rural population. It investigated the impact of facilitating therapist-family contact using 1) scheduled telephone sessions, 2) scheduled emails, or 3) as-needed client initiated contact, as compared to a wait-list control group. Measures used included the Anxiety Disorders Interview Schedule for Children (ADIS-C-IV) and 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). The Cool Kids Outreach treatment protocol was adapted from the standard cognitive behavioral group treatment program based on the Cool Kids anxiety program. The treatment conditions and waitlist lasted for a 12-week period, at which time the post-treatment assessment was conducted. A long-term follow up was conducted 12 months after the post-treatment assessment with a subset of families. Results indicated 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 included 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 lack of 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, 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 — Children: 36% 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 study evaluated the feasibility of the Cool Kids Program 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 [now called Cool Kids Outreach]), 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 reliance on self-reported measures, generalizability to other populations, and 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: Rural county of California by the United States Mexico Border

Summary: (To include basic study design, measures, results, and notable limitations)
The study evaluated the feasibility of the Cool Kids Outreach Program modified for use with rural Latino/as. Participants were randomly 1 of 2 modes of parent-mediated CBT bibliotherapy: (1) telephone-delivered, therapist-assisted bibliotherapy (TTB; n =15), and (2) a more minimal contact, self-directed, bibliotherapy condition (SB; n =16). 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, and Children's Automatic Thoughts Scale (CATS). Results indicated 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 (N= 25) were 50% and 36% for the TTB and SB groups, respectively. Limitations include small sample size, lack of control group, generalizability to other populations due to ethnicity and gender, and lack of follow-up.

Length of controlled postintervention follow-up: None.