The Effectiveness of Applying the Coping Cat Protocol on Reducing Symptoms of Separation Anxiety Disorder in the Children (A Case Study)

Early diagnosis and treatment of mental disorders in childhood is very important. One of the most common childhood mental disorders is separation anxiety disorder. Epidemiological studies showed that between 2.1 and 6.6 percent of children have this disorder. There are three signs of excessive separation discomfort, such as severe and persistent anxiety about being deprived and harmed, fear and helplessness of separation, physical complaints, recurring nightmares, fear of school, and sleep problems that last at least 4 weeks, is necessary for diagnosis of separation anxiety disorder. Three-quarters of school-leaving children suffer from separation anxiety disorder and if left untreated, they may develop generalized anxiety disorder. Therefore, it is very important to pay attention to the treatment of this disorder, especially in preschool and primary school ages. One of the most widely used methods of treating anxiety disorders in children is the Coping Cat method. Philip Kendall was the first person that offered the Cognitive-Behavioral therapy to children. He developed the first step-by-step method for treating children's anxiety based on a cognitive-behavioral approach called the “Coping Cat” method. Each session of this treatment includes goals, implementation instructions, and tips. Techniques used in this method include identifying feelings of anxiety and bodily reactions, relaxation, reviewing and changing anxiety self-expression, problem solving, performance appraisal, and practicing hierarchical exposure to anxious situations. The results of clinical trials support the use of cognitive-behavioral therapy for children and adolescents with anxiety. The aim of this study was to evaluate the effectiveness of using the coping cat method on reducing the symptoms of separation anxiety disorder in children.

Method was single-case and experimental with baseline. The subjects included a 7-year-old girl and an 8-year-old boy who were diagnosed with separation anxiety disorder based on purposive sampling and after conducting a diagnostic interview and testing, and were selected according to the inclusion criteria and fulfilling the research conditions. After performing the baseline, participants entered the treatment and the coping cat method was performed during 10 sessions for them, individually. Therapeutic changes, recovery percentage, and effect size from the beginning to the last session were obtained using the Clinical Symptoms Index (SCI-4). This instrument has two forms: parent (97 items) and teacher (77 items). SCI-4 is applied for screening thirteen behavioral and emotional disorders including: Attention Deficit Hyperactivity Disorder (ADHD), Oppositional Defiant Disorder (ODD), Conduct Disorder (CD), Generalized Anxiety Disorder (GAD), Social Panic, Separation Anxiety Disorder (SAD), Obsessive-Compulsive Disorder (OCD), Specific Panic, Major Depression Disorder (MDD), Dysthymia, Schizophrenia, Pervasive Developmental Disorder, Vocal and Motor Tics, Post-Traumatic Stress Disorder (PTSD), Elimination Disorders (Enuresis and Encopresis). In this study, only parts related to anxiety disorders were used. Scoring is done in two ways. One is zero and one and the other is zero, one and two. For more accuracy, the second method was used in this study. The sensitivity and specificity of SCI-4 with Iranian samples have been determined by the psychiatrist's diagnostic agreement based on different cut-off points and the best score for each disorder. The intervention package used in this study included 10 sessions of training and cognitive-behavioral intervention that are included in Kendall's treatment protocol. Each session includes goals, implementation guides, and tips, and concludes with helpful tips on covering up associated disorders during treatment and managing issues that may complicate the treatment process. The techniques that used in this method are: identifying feelings of anxiety and bodily reactions, relaxation, examining and transforming anxiety self-expression, problem solving, performance appraisal, and practicing hierarchical exposure to anxious situations. Also, at the end of each session, an enjoyable activity is performed.

The results of this study showed that applying the coping cat protocol is effective in reducing the symptoms of separation anxiety disorder in children and reduces the severity, frequency, and complexity of the symptoms of separation anxiety disorder. The first subject (Mina) showed more changes than the second subject (Sepehr) in all indicators related to the rate of recovery. This finding may indicate that the coping cat method is more effective in school-age girls than boys. One month after the intervention and follow-up, the indicators related to the percentage of recovery indicated the persistence of therapeutic effects. Another finding of this study was the clinical efficacy obtained using Cohen's “d” formula. The intensity, frequency, complexity, and interference indices for the first subject were 1.52, 2.27, 1.69, and 1.54, and for the second subject were 1.08, 1.57, 1.22, and 1.42, respectively. The obtained scores indicate the optimal effectiveness of the coping cat method in reducing the symptoms of separation anxiety disorder. Also, the graphs related to the pattern of change in scores showed that changing scores on the scales of intensity, frequency, complexity, and interference in the process of educational-therapeutic sessions and follow-up (that mentioned in the coping cat method for cognitive-behavioral therapy of anxiety disorders) has been effective to reduce symptoms of separation anxiety disorder in the subjects.

According to the results of this study, it can be said that applying coping cat protocol can be a useful intervention in reducing the symptoms of separation anxiety disorder and even treating it completely, along with other therapies. Because the results of baseline diagrams, recovery percentage, and effect size showed significant therapeutic changes in the rate of separation anxiety symptoms in the subjects. This finding is consistent with the results of previous research. The use of techniques and methods in this treatment reduces anxiety symptoms such as anxiety, restlessness, abuse, and abnormal reactions in children. Although some studies have emphasized the effectiveness of parent-centered interventions in reducing anxiety symptoms, but both treatments can be used simultaneously to achieve maximum recovery. Preschool interventions have special considerations due to the developmental characteristics of these children, such as lack of subjective thinking, inability to read and write, and being more affected by early relationships with family members. Therefore, due to the fact that separation anxiety disorder is very common in children and also due to its adverse consequences such as school attendance problems, its treatment is very important and children who experience the coping cat method, after treatment and also in the follow-up stage shows a significant reduction in their separation anxiety symptoms. According to the desirable efficiency and effectiveness of this method, its use is recommended for the treatment of children with anxiety.