Identifying a research process and critically analysing its statistical significance - in order to look at a more specific way of treating anxiety related disorders in young children the selected paper, Evaluating a cognitive behavioural therapy gr
Identifying a research process and critically analysing its statistical significance.
The long term impact of anxiety disorders in children can affect their social interactions, personal relationships and future academic/career progression. This can result in family dysfunction, substance abuse or/and other mental disorders (Allgulander & Lavori 1991; Burton 2006 as cited in Manassis et al 2009 p 1). Research in this area is extensive and in order to look at a more specific way of treating anxiety related disorders in young children the selected paper, 'Evaluating a cognitive behavioural therapy group program for anxious five to seven year old children: A pilot study' (Monga et al 2009) has been chosen to assess the teams particular use of research methods, data analysis and what the outcome of an adapted form of Cognitive Behavioural Therapy has on treating anxious 5-7 year olds.
The significance of the research.
The research article was developed by Dr. Young (SFU 2011) and two child psychiatrists, Dr. Suneeta Monga and Dr. Mary Owens at the Hospital for Sick Children in Toronto who also provided sponsorship.
There is evidence to show that anxiety in children can start at a young age (Cartwright-Hatton 2004). Previous research has been carried out primarily on children above the age of 8. Dr Young and her team had looked at the methods used for treatment from previous research such as the FRIENDS program (Shortt 2001) which concluded CBT too linguistically and cognitively demanding for children under 8. The team decided to look at alternative ways using CBT but adapted, to suit treating anxious children under 8. The team's innovative method of treatment was named 'Taming "sneaky fears" child and parent treatment manual'. This adapted form of CBT would be applied through stories, games and activities. These methods where seen as more appealing to younger children under 8 as they aimed at engaging with them through play thus allowing them to feel comfortable which in turn would hopefully facilitate communication (Monga et al 2009).
Cognitive Behavioural Therapy (CBT) is seen as effective in treating children and adolescents and this has been demonstrated in numerous research studies (Flannery-Schroeder 2000; Manassis 2002; Muris 2001). The research so far has suggested/concluded that ..... CBT is now seen as a favourable choice for practitioners treating anxiety related disorders in children (Compton 2004; Ishikawa 2007).
The Research methods
The research was a pilot study which enabled the team to test the outcome of their treatment manual. The pilot study would give them the chance to reflect on their use of multiple methods for assessing the statistical significance of their theory and any changes could be made to the treatment manual before its publication (McLeod 2003).
This research paper in particular is referred to as 'outcome research' which means to test the validity and reliability of a particular theory, in this case a treatment manual (McLeod 2003). The Philosophical approach to researching a subject such as a psychotherapeutic intervention is usually researched using Qualitative methods as it will often take in to consideration the context of the origins of the data in a more subjective manner ie; Counselling and Psychotherapy deals with human contact, thoughts, feelings and differing circumstances. The drawback to this is it's hard to keep the research contained which could makes it difficult, time consuming and personally overwhelming for the researcher. Ethics also have an extremely important role to play in qualitative research; Cultural, social and personal prejudice would need to be considered as it may affect the quality of the research. There is an ethical importance for a researcher to set appropriate boundaries and to take the appropriate measures to have their research ethically reviewed whether it's qualitative or quantitative (McLeod 2003 & Salford 2011).
A deductive approach would be used in the development of new methods and would be more satisfied by qualitative research, this may have been used in the development of the manual ie; Asking questions and exploring concepts in order to come up with a new hypothesis, in this case 'how can CBT be used to treat children under 8?', 'could it be used if we adapted it?', 'We have adapted it, does it now work?'.
Now that they had a hypothesis to test 'Does the treatment manual work?' A Quantitative research method would test if their ...
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A deductive approach would be used in the development of new methods and would be more satisfied by qualitative research, this may have been used in the development of the manual ie; Asking questions and exploring concepts in order to come up with a new hypothesis, in this case 'how can CBT be used to treat children under 8?', 'could it be used if we adapted it?', 'We have adapted it, does it now work?'.
Now that they had a hypothesis to test 'Does the treatment manual work?' A Quantitative research method would test if their theory could be nullified or rejected, this is called determining the statistical significance of a null hypothesis, in other words 'yes it can and this can be proven by the results' or 'no it can't as the test results show little significant change to the participants' (Salford 2011). It could be also said that by using a Quantitative method for outcome research the researchers would attempt to satisfy modern society's demands for scientific evidence which is the influence of French sociologist Auguste Comte (1798-1857). Comte's 'positivism' philosophy set a methodological ideal standard for all humanities ie; scientific knowledge develops from the deducing and testing of hypotheses (Melling 2011). The popularity of evidence based science has put pressure on helping practices weather it be medical, pharmaceutical or holistic, to 'legitimise' their theories (McLeod 2003).
The participants
The team chose to interview the parents of 32 children and a clinician trained in the practice of the treatment manual. The children would be treated through a variation of group and individual therapy to test out all the possibilities of outcome ie; a child may respond better with one to one therapy rather than in a group of say 8 adults and children, especially if they have a social anxiety. Also therapy conducted without their parents present may make a difference to the outcome as a parent may display anxiety disorder of their own which exaggerates the child's condition, also a child may feel afraid to disclose any contributing factors in the home life that has impacted on their condition if their parents are present in the therapy room (Gosh 2006). In all cases all the variations of treatment must adhere to professional codes of ethics and practice in order to safe guard the child. There was no indication in the research paper that this had been done.
All children met criteria for at least one DMS-1V anxiety disorder (2010) based on a clinical interview and semi structured interview (ADIS-P) (Silverman 1996). It was noticed that the team chose children from different demographic origins (27 white, 4 Asian, 1 African descent) but did not comment on the ethical significance of different cultural and social beliefs, values and customs that could affect the parent's answers during interviews and in the questionnaires (Edwards 1957, Vernon 1963 as cited in McLeod 2003 p68). For example, what one culture sees as 'aggressive' another may think is just 'spolit'! In the case of social desirability of an answer, saying 'no' to a question because you consider a 'yes' may have a social prejudicial outcomes towards the family as a whole. It was also noticed that there were 20 children who presented with a co-morbidity of anxiety disorders, It was not entirely clear who had what and how many disorders they where diagnosed as having, but it could be said that multiple disorders could affect the answers to the parental questionnaires as one symptom could apply to one anxiety disorder and not to another. It has been suggested in previous research similar to Monga et al (2009) that pseudo educating the parents on the differences between the various anxiety disorders, recognising symptoms and managing the condition would make a significant difference to the outcome of an answer on a test (Suveg 2006). What a parent initially thought was a high scoring symptom could now have a re-educated opinion as results of pseudo education and upon re-taking the test after treatment scores it lower. To omit some kind of pseudo education may have a dramatic effect on results; from the uncertainty of the parents answer, the researcher is now in danger of making a type II error (beta) from the results, in other words the researcher may have accepted a null hypothesis that the theory works from the results but in fact the results may not have been confirmed by the questioning method (Duerden 2010).
Data analysis
The clinician's rating of the Childs anxiety disorder was tested using the Children's Global Assessment Scale - CGAS (Shaffer 1983). The conclusions where that treatment had an effect on improving symptoms of anxiety and the CGAS score on the scatter diagram concluded a statistical significance in the chance of a null hypothesis (p = 0.001). From this statistic it was said that pre treatment and post treatment assessment using 5 different methods of assessment produced a 1 in 1000 chance that the results could be dis-proven if the research was to be done again.
The reasons why they may have chosen 5 different research questionnaires/ interviews and 2 forms of data analysis is that the combination of tests enabled a sufficient variation when reporting on multiple comparisons. This is referred to as a triangulation of research methods (McLeod 2003). The findings form one type of study such as a qualitative approach to developing the treatment manual, then testing the effectiveness of the manual using a quantitative research study would encompass many perspectives and would hopefully clarify a statistical significant result in the research conclusions (McLeod 2003).
Conclusions
It was noticed that Dr. Young and her teams' manual had not yet been published. This could be down to numerous possibilities but perhaps the results of the pilot test, although statistically significant, highlighted areas for improvement. It was noticed that 2 months later after the research carried out with Dr Young and Mary Owens (2009), Suneeta Monga participated in a research that looked more specifically at the quantitative measurement of feelings in a computerised feelings assessment instrument called MACC (Manassis 2009). These findings highlighted the importance of 'fine tuning' testing methods, adapting theories and re-testing hypothesis. Constantly reassessing treatment methods would validate outcomes and enhance the probability of cure or symptom management. A triangulation of different research methods would further enrich a Psychotherapeutic theory and support the hope for a statistical significance.
References
Beitchman, J. H., Adlaf, E. M., Douglas, L., Atkinson, L., Young, A., Johnson, C. J., & ... Wilson, B. (2001) Co-morbidity of psychiatric and substance use disorder in late adolescence: A cluster analaytic. American Journal Of Drug & Alcohol Abuse, 27(3), 421.
Birmaher B, Khetarpal S, Brent D et al (1997) The Screen for Child Anxiety Related Emotional Disorders (SCARED): scale construction and psychometric characteristics. J Am Acad Child Adolesc Psychiatry;36:545-553.
Blatt et al (1996) Characteristic of effective therapists: further analysis of data from the National Institute of Mental health treatment of depression collaborative research program. Journal of Consulting and Clinical Psychology , 64 (6) :1276 -84
Burton (2006) Psychiatry (pp.161 ff.). Malden, MA: Blackwell.
Carey WB (2000) The Carey Temperament Scales Test Manual. Behavioral-Development Initiatives. Scottsdale, AZ.
Cartwright-Hatton S, Roberts C, Chitsabesan P,Fothergill C, Harrington R. (2004) Systematic review of the efficacy of cognitive behaviour therapies for childhood and adolescent anxiety disorders. Br J Clin Psychol; 43:421-436.
Chrits -Christoph et al (1991) Meta analaysis of therapist effects in Psychotherapy outcome studies. Psychotherapy research 1 (2): 81-91.
Cohen AP, Cohen J, Brook J. (1993) An epidemiological study of disorders in late childhood and adolescence: II. Persistance of disorders. J Child Pschol 34:869-877.
Cohen J (1988) Statistical Power Analysis for the Behavioral Sciences.2nd ed. Lawrence Earlbaum Associates. Hillsdale, NJ.
Connors CK. (1998) The revised Connor's Parent Rating Scale (CPRS-R). Factor structure, reliability and criterion validity Abnorm Child Psychol;40:265-279.
Compton SN, March JS, Brent D, Albano AM, Weersing VR,Curry J. (2004) Cognitive-behavioural psychotherapy for anxiety and depressive disorders in children and adolescents: an evidence based medicine review. J Am Acad Child Adolesc Psychiatry;43:930-959.
DSM-IV-TR. (2010) American Psychiatric Association (4th ed). DSM-IV-TR. American Psychiatric Publishing, VA.
Duerden T (2010) Statistical significance-10.doc [handout] School of Community, Health and Social Care, University of Salford. [Online] Available at http://vle.salford.ac.uk . Accessed on 22th Dec 2011 at 15:12pm.
Flannery-Schroeder EC, Kendall PC (2000) Group and individual cognitive-behavioural treatments for youth with anxiety disorders: a randomized clinical trial. Cogn Ther Res;24:251-278.
Gosh E. A., Flannery-Schroeder, E., Mauro, C. F., & Compton, S. N (2006) Principles of Cognitive-Behavioural Therapy for Anxiety Disorders in Children. Journal of Cognitive Psychotherapy, 20(3), 247-262. Retrieved from EBSCOhost.
Ishikawa S, Okajimi I, Hirofumi M, Sakano Y (2007) Cognitive behavioural therapy for anxiety disorders in children and adolescents: a meta-analysis. Child Adolesc Ment Health;12:164-172.
Lambert (1989). The Individual therapists' contribution to psychotherapy process and outcome. Clinical Psychology review 9: 469-85
Lieberman, Yalom and Miles (1973) Encounter groups: First facts . Basic Books, New York.
Manassis, K., Mendlowitz, S et al (2002). Group and Individual CBT for childhood anxiety disorders: a randomized trial. J Am Acad Child Adolesc Psychiatry. 41:1423-1430
Manassis, K, Mendlowitz, S, Kreindler, D, Lumsden, C, Sharpe, J, Simon, M, Woolridge, N, Monga, S, & Adler-Nevo, G (2009), 'Mood Assessment Via Animated Characters: A Novel Instrument to Evaluate Feelings in Young Children With Anxiety Disorders', Journal Of Clinical Child & Adolescent Psychology, 38, 3, pp. 380-389, Academic Search Premier, EBSCOhost, viewed 22 December 2011.
McLeod (1998) An Introduction to Counselling, (2nd ed). Open university press , Buckingham
Mc Leod (2003) Doing Counselling Research. 2nd edn. SAGE publications, London.
Melling B (2011) Intro in to Research. [Online] Available at http://vle.salford.ac.uk . Acceseed on 15th Dec 2011 at 15:12pm
Monga, S., Young, A., & Owens, M. (2009) Evaluating a cognitive behavioral therapy group program for anxious five to seven year old children: a pilot study. Depression & Anxiety (1091-4269), 26(3), 243-250. doi:10.1002/da.20551
Monga, S., Birmaher, B., Chiappetta, L., Brent, D., Kaufman, J., Bridge, J., & Cully, M. (2000) Screen for child anxiety-related emotional disorders (SCARED): Convergent and divergent validity. Depression & Anxiety (1091-4269), 12(2), 85-91.
Muris P, Mayer B, Bartelds E, Tierney S, Bogie N. (2001) The revised version of the Screen for Child Anxiety Related Emotional Disorders (SCARED-R): treatment sensitivity in an early intervention trial for childhood anxiety disorders. Br J Clin Psychol;40:323-336
SFU (2011) Children's Social Emotional Development Lab [online] http://www.sfu.ca/csedl/ accessed on 05/12/2011 at 13.56pm
Shaffer D, Gould MS, Brasic J et al (1983) A Children's Global Assessment Scale (CGAS). Arch Gen Psychiatry 40:1228-1231.
Shortt AL, Barrett PM, Fox TL. (2001) Evaluating the friends program: a cognitive behavioural group treatment for anxious children and their parents. J Clin Child Psychol;30:525-535.
Silverman WK, Albano AM. (1996) The Anxiety Disorders Interview Schedule for Children for DSM-IV: Clinician Manual (Child and Parent Versions) Psychological Corporation. San Antonio, TX
Suveg, C., Roblek, T. L., Robin, J., Krain, A., Aschenbrand, S., & Ginsburg, G. S. (2006) Parental Involvement When Conducting Cognitive-Behavioral Therapy for Children with Anxiety Disorders. Journal of Cognitive Psychotherapy, 20(3), 287-299. Retrieved from EBSCOhost.
Bibliography
ANOVA (2011) Analysis Of Variance between groups [online] http://www.physics.csbsju.edu/stats/anova.html . Accessed on 21/12/2011 at 15.23pm
DSM-IV-TR. (2010) American Psychiatric Association (4th ed). DSM-IV-TR. American Psychiatric Publishing, VA.
Duerden T (2010) Statistical significance-10.doc [handout] School of Community, Health and Social Care, University of Salford. [online] Available at http://vle.salford.ac.uk . Accessed on 22th Dec 2011 at 15:12pm.
Gosh E. A., Flannery-Schroeder, E., Mauro, C. F., & Compton, S. N. (2006) Principles of Cognitive-Behavioral Therapy for Anxiety Disorders in Children. Journal of Cognitive Psychotherapy, 20(3), 247-262. Retrieved from EBSCOhost.
Manassis, K, Mendlowitz, S, Kreindler, D, Lumsden, C, Sharpe, J, Simon, M, Woolridge, N, Monga, S, & Adler-Nevo, G (2009) 'Mood Assessment Via Animated Characters: A Novel Instrument to Evaluate Feelings in Young Children With Anxiety Disorders', Journal Of Clinical Child & Adolescent Psychology, 38, 3, pp. 380-389, Academic Search Premier, EBSCOhost, viewed 22 December 2011.
Monga, S., Young, A., & Owens, M. (2009) Evaluating a cognitive behavioral therapy group program for anxious five to seven year old children: a pilot study. Depression & Anxiety (1091-4269), 26(3), 243-250. doi:10.1002/da.20551
Mc Leod (2003) Doing Counselling Research. (2nd ed). SAGE publications, London.
Melling B (2011) Intro in to Research.[online] Available at http://vle.salford.ac.uk . Acceseed on 15th Dec 2011 at 15:12pm
Suveg, C., Roblek, T. L., Robin, J., Krain, A., Aschenbrand, S., & Ginsburg, G. S. (2006) Parental Involvement When Conducting Cognitive-Behavioral Therapy for Children with Anxiety Disorders. Journal of Cognitive Psychotherapy, 20(3), 287-299. Retrieved from EBSCO host.