• By Laura Whybra
  • Posted on Friday 16th May, 2014

Now that’s a great story

strong>Reading is fun. But can it be therapeutic, too? In Canadian schools, reading and discussing stories about childhood problems improved 9-12 year olds’ coping skills and reduced risk factors for anxiety disorders.New research has found that a universal prevention program using storybooks that depict common childhood problems, in combination with group workshops, may help to prevent anxiety disorders. In a small randomized control trial, a Canadian research team tested the effects of a 10-session cognitive behavioral program called “Dominque’s Handy Tricks.” The program uses a well-known series of stories that deal with common stressors rather than situations that are specific to anxiety disorders. They found that, compared to children on a waitlist, children in the program “used more problem-solving strategies, perceived themselves as more able to cope with stressors, were less sensitive to anxiety, showed less clinical signs of anxiety, and had fewer phobic fears.” The results remained strong nine months after the program. A storybook approachDominique’s Handy Tricks targets cognitive and behavioral factors that are common across all anxiety disorders, including beliefs that unknown or uncontrollable situations are threatening. In each of 10 weekly school-based sessions, upper elementary school aged children hear one of the “Dominique” stories, and then discuss how how book characters coped with common stressful situations, such as bed-wetting, school expectations, divorce, bullying, and social rejection. Each workshop targets a “handy trick” – a specific coping skill. Skills include recognizing anxiety symptoms, questioning your thoughts, not avoiding problems, confiding in others, and using your social support network.Many programs that address anxiety focus on anxiety symptoms, irrational beliefs, and anxiety disorders, the researchers note. The Dominique books are different: because they were not written specifically for anxiety disorders, many of the stories deal with common stressors. By focusing on stressors rather than symptoms of anxiety, Dominque’s Handy Tricks gives anxious children the opportunity to explore their concerns in a group setting without making personal disclosures. The focus on realistic situations can also help kids see that emotional reactions are normal, gives them a palette of skills to apply to daily situations, and avoids adding to their worries by introducing new concerns typical to anxiety disorders. The Quebec studyIn this study, researchers invited all fifth- and sixth-grade students in eight Quebec schools to participate in the study. As the program focuses on prevention, children who expressed interest in participating were screened for emotional and behavior problems and for anxiety disorders. Those who met clinical thresholds were referred for treatment. Then 29 participants were randomly allocated to participate in the program, and 30 to a waitlist for future participation. Researchers used a battery of self-report questionnaires and clinical screening tools to assess outcome measures immediately before and after participation and at a nine-month follow up. Outcome measures included protective factors against developing anxiety disorders (such as the ability to use coping strategies), risk factors for developing anxiety disorders (such as sensitivity to anxiety), and clinical levels of anxiety. At the end of the program, researchers found that children who attended the workshops showed improved problem solving skills, coping skills, and belief in their own ability to solve their problems, in addition to reduced sensitivity to anxiety and reduced clinical symptoms of anxiety. At this time, the children on the waitlist showed no difference in any of these measures compared to immediately before the program. At the nine-month follow-up assessment, researchers found that children who had participated in the program showed further improvements in problem solving skills, sensitivity to anxiety, and symptoms of anxiety. Additional analyses found that the program had a bigger impact on children with higher overall sensitivity to anxiety. Limitations and implicationsThis was a small study with a substantial rate of attrition. Of 59 children who were enrolled in the trial, 46 were evaluated at the post-trial assessment. Only 34 completed the nine-month follow-up. In addition, it is not clear how the children who participated compare to the general population of schoolchildren in Quebec, so it is hard to know whether the program would be as effective with a broader group. In addition, the nine-month follow up analyses included both groups of children – at this point, the children on the waitlist had attended the workshops. As there was no control group comparison at the final time point, the further improvements found could be due to another factor. The consequences of anxiety disorders are complex, including isolation and peer rejection. For a universal prevention program to be effective in preventing anxiety, the researchers argue, it should be inclusive and non-stigmatizing. Indeed, previous research has shown negative peer effects of labeling children as anxious. Storybooks should reduce this risk. When children talk about how fictional characters handled stressful situations, they can imagine how to use cognitive-behavioral strategies to resolve their own problems – without having to confess to their own worries in front of their peers.Implementing prevention programs in schools is a good way to reach large numbers of children. The current research findings suggest that the Dominique’s Handy Tricks program is a promising intervention for a school setting.************Reference:Bouchard, S., Gervais, J., Gagnier, N., & Loranger, C. (2013). Evaluation of a primary prevention program for anxiety disorders using story books with children aged 9-12 years. Journal of Primary Prevention, DOI 10.1007/s10935-013-0317-0

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