This document summarizes a study on the effectiveness of cognitive behavioral therapy (CBT) for children in private practice. The study found that CBT significantly reduced children's behavioral problems, anxiety, and depression from pre- to post-treatment. It also increased children's ratings of well-being and therapeutic alliance. While depression symptoms decreased, they remained in the clinical range. Having more treatment sessions and including parents may further improve outcomes.

1. Effectiveness of CBT in private practice:
Children
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Pietrzak, T., Morgan, L., Collard, J., Gilson, K., Wong, G., Pope, G., O’Kelly, M.

2. 7 Good Reasons to treat childhood disorders?
1. Globally 20% children suffer disabling mental illness.
2. Suicide 3rd leading cause of death among adolescents.
3. Up to 50% of adult mental disorders have origins in
childhood.
4. Child mental health problems common, serious and linked
to pre-mature death, serious adult dysfunction, school
failure, criminality, drug/alcohol dependence, accidents,
self harm, sexual risk taking.
5. Increased burden to family, community, government.
6. Unrecognized childhood disorders lead to harsh physical
punishment, abuse, stigmatization, exclusion.
7. Adolescence vulnerable time
Copyright Dr Tania Pietrzak CBT Australia 2015

3. Directive from
Coalition
• Psychologists are directed to use focused psychological strategies:
CBT
• ATAPS 12-18 & Better Access 10 sessions per calendar year,
previously 16.
• Unclear future of Better Access
• Coalition has not yet stated its position on mental health funding
nor contributed its mental health policy to APS on their key mental
health issues.

4. Purpose of Study
To evaluate whether treatment of children using CBT
in private psychology practice under government
funded initiatives is effective.

5. Hypotheses
1. Children would have a statistically significant
and meaningful decrease in total behavioral
problems, anxiety & depression from pre to
post test at time 1 (first review) and time 2
(second review)
2. Children would have a statistically significant
and meaningful increase in outcome ratings
(well being) and session ratings of therapeutic
alliance from pre to post test at time 1(first
review) and time 2 (second review).

6. •Seven psychologists – all with clinical
endorsement
•PhD – 3, D Psych – 2, M Clin Psych – 3
•All completed advanced training course with
CBT Australia
•Commenced associate fellowship training in
REBT
•Training at Beck institute – 3
•One also trained at Albert Ellis Institute-
fellowship

7. Method
•Ethics approval obtained from Monash University
Human Research Ethics Committee
•Data collection commenced Feb 2014 and
continued for 24 months
• Client consent obtained for participation in study
at first session.
•Uniform measures taken at 1st, 6th, 10th and final
sessions
•CBT intervention .

8. Assessment
a) Centre For Epidemiological Studies Depression
Scale for Children (CES-DC)
b) Spence Anxiety Scale (child version)
c) Child Behaviour Checklist

9. 40-60% youth drop out of treatment (Kasdin, 2004)
Often mandated to come by parents
Little control over therapy process leading to poor engagement
Therefore to monitor and improve children’s effectiveness in
treatment we included:
a) Child Outcome Rating Scale (measure of child’s self reported
wellbeing) (Miller 2003; Duncan et al., 2006)
b) Child Session Rating Scale (self report measure of therapeutic
alliance) (Miller; 2003; Duncan et al., 2006)
Giving
children a
voice

10. Me
(How am I doing?)
I----------------------------------------------------------------------I
Family
(How are things in my family?)
I----------------------------------------------------------------------I
School
(How am I doing at school?)
I----------------------------------------------------------------------I
Everything
(How is everything going?)
I----------------------------------------------------------------------I
Institute for the Study of Therapeutic Change
_____________________________________ www.talkingcure.com
© 2003, Barry L. Duncan, Scott D. Miller, & Jacqueline A. Sparks

11. Results
Clients N
Total number consenting 92
Children Retested on measures at T1: Range 27-58
Children Retested on measures at T2: Range 2-9

12. Demographic Results
Gender: Male – 46.48% Female – 56.52%
Age: Range 3 years -16 years Median 9.97 years SD 3.25
Education: Range Kinder - Year 11
Funding: Medicare – 76.09% Private – 2.17%
ATAPS – 13.04% TAC – 1.09%
Helping children with autism – 7.61%
Previous diagnosis: 64.13% had no previous diagnosis
Previous treatment: 51.09% had no previous treatment
Medication: 78.26% not on medication

13. CBCL: paired sample t-tests
M
pre
M Post
1st
Review
M
change
SD t p Classification
Total
n=33
62.4 50.06 12.42 22.2 3.2 .003
**
Borderline to
normal

14. Demographic Predictors of change on CBCL :
ANOVA
• Education level predicted change (improvements) for
attention problems F 2.37 (df 9), p=04 and a trend towards
reducing somatic complaints F 2.26 (df 9), p=0.056.
• Year 7s had greatest reduction
• Previous diagnosis predicted change (worse) for social
problems F 4.34 (df 1 ), p=0.046
• Medication trend towards predicted change (improvement)
on attention problems F 3.89 (df 1), p=0.057

15. Results: Depression paired sample t-tests
Clinical Cut off Score 15
M
pre
M Post
1st
Review
M
change
SD t p Classification
CES-DC
(n=29)
22.0
3
18.1 3.93 9.81 2.1
6
.004
**
Remains
clinical
Spence
(N=27)
36.1
9
29.48 6.7 11.14 11.
11
P<0.
0001
***
Post test
scores in
normal range

16. Results: CORS & C-SRS
M
pre
M Post
1st
Review
M
change
SD t p Classification
ORS cut off 32
SRS cut off 36
ORS
(n=58)
25.24 32.00 -6.7 8.24 -4.12 <.0001 Below to within
range
SRS
(n=51)
33.2 36.45 -3.24 5.63 6.19 <.0001 Below to within
range
M
Pre
M Post
2nd
Review
M
change
SD t p
ORS
(n=9)
27.27 33.54 -6.27 5.9 -3.19 0.01 Below to within
range
SRS
(n=8)
32.79 38.77 -5.98 3.45 -4.9 0.002
**
Below to within
range

17. Effect Sizes- meaningful sizeable difference between
pre- post test
Pre-
Post T1
Pooled
SD
Cohen’s D
Effect Size
Pre -Post T2
Pooled SD
Cohen’s D
Effect Size
*CBCL 31.22 0.398 (small) 17.99 1.19 (large)
CES-DC 12.05 0.33 (small) 15.92 0.38 (small)
*Spence 17.44 0.38 (small) 9.06 0.88 (large)
**ORS 8.13 0.83 (large) 6.32 0.99 (large)
*SRS 5.26 0.62
(medium)
2.87 2.08 (large)

18. Discussion
• For children aged 3 - 16 years, CBT has a statistically and
clinically significant impact on reducing anxiety, depression
& total behaviour problems as early as 6 sessions
• Preliminary data with small sample sizes at time 2 meant low
statistical power
• Children’s anxiety on average moved from the elevated to
normal range at the end of the sixth session.
• Depression – symptoms reduced, but remained within the
elevated range, harder to treat within 1 cycle of therapy,
consistent with literature.

19. Discussion
• Education Level (year 7) predicted reduction in attention
problems over time. No effects were found for previous
treatment, gender or previous diagnosis.
• A trend: medication predicted a reduction on attention
problems.
• Implications for the use of medication with CBT to treat
attention problems

20. Discussion
• The inclusion of the SRS and ORS provides valuable
information for the clinician in relation to their
understanding of the child’s well-being and feeding this back
to the child to enhance effectiveness outcomes.
• Children’s ratings of therapeutic alliance improved longer
they stayed in therapy.
• Many of the children may find it difficult to evaluate their
own anxiety, but can more easily estimate their wellbeing on
a scale

21. Limitations
• The nature of work with children can often be chaotic and
therefore completing outcome measures can often be
overlooked
• No follow-up data to assess whether change is maintained
• Greater sample sizes at time 2 needed… our difficulties
reflected both attrition (we don’t know why some children
stopped therapy just before or after 1st review) and
difficulties obtaining & having feedback measures returned.

22. Future research
• This study did not evaluate the parent’s perception of the
child’s anxiety or the impact of parenting interventions on
child outcomes.
• Inclusion of parent ratings of child wellbeing and parent
wellbeing on the C-ORS and ORS may be helpful to increase
even greater effectiveness of child outcomes
• Evaluations at 3 and 6 months follow up to see how change
is maintained.
• Do children with neurobiological disorders (ADHD and
Autism) progress differently through treatment compared to
children with other diagnoses?