Development, implementation and evaluation of a Cognitive Behavioural Therapy based intervention programme for the management of anxiety symptoms in South African children with visual impairments

[摘要] ENGLISH ABSTRACT: Anxiety is the most common psychological problem reported by children and adolescents. Anxiety is even more common in children with visual impairments. If anxiety symptoms occur and are left untreated, this may result in negative consequences. Promising is that Cognitive behaviour therapy (CBT) interventions have proven successful in treating childhood anxiety. However, most existing CBT-based anxiety intervention programmes are not suitable for use with children with visual impairments, as their content (i.e., cartoons, colouring-in pictures, workbook and visual-based activities) are not very accessible to this specific population.Therefore, the present study was motivated by the dearth of research on this topic and the study aimed to develop, implement and evaluate a specifically tailored anxiety intervention programme which could be used with South African children who have visual impairments.A randomised wait-list control group design with pre-, post- and follow-up intervention measures was employed. The final sample of 52 assenting children (aged 9-13) with varying degrees of visual impairment from two special schools in the Western Cape were delivered the anxiety intervention (PAM programme). Participants were randomly allocated to either an immediate intervention group (IIG) (n = 27) or a delayed intervention group (DIG) (n = 25) at each of the two schools. Participants were followed over a course of ten months during which participants' anxiety symptoms were assessed quantitatively at four time points (T1-T4). All children were administered a short biographical questionnaire and two anxiety measures including the 30-item Revised Child Anxiety and Depression Scale (RCADS-30) and the Penn State Worry Questionnaire for Children (PSWQ-C). The administration of these measures was adapted according to the participant's degree of visual impairment. Qualitative data pertaining to the accessibility and feasibility of the PAM programme were also gathered.In terms of the main outcome measure, contrary to what was expected, initial statistical results indicated that the PAM programme did not bring about a significant reduction in symptoms of anxiety within the sample of children with visual impairments. More specifically, anxiety scores on the RCADS-30 and PSWQ-C yielded non-significant outcomes throughout, as neither significant between-group nor within-group effects were noted for the IIG (n = 27) or DIG (n = 25) at any of the four times of testing (T1-T4).However, although desired intervention effects were not obtained, the programme showed promise in terms of preventive effects, as no participant who reported sub-clinical symptoms of anxiety at T1 had moved to within the clinical range at T4. Thus, although this was not statistically determined, it seems that exposure to the PAM programme prevented an increase in anxiety symptoms. The qualitative data revealed that both participants (N = 52) and research facilitators (n = 3) deemed the accessibility of the PAM programme to be acceptable. It appears that it was feasible to deliver the PAM programme at the two special schools. However, good infrastructure, discipline, organisation and routine play an important role to make the implementation of the programme much easier. In conclusion, a critical review of the present study and recommendations for future research are provided.

[发布机构] Stellenbosch University