Este trabalho apresenta o processo iterativo de criação, desenvolvimento e avaliação de um programa de computador para psicoeducação sobre Transtorno Obsessivo-Compulsivo (TOC). Na primeira fase foi criado um protótipo interativo e autoadministrado. A segunda fase consistiu em avaliações com experts, que levaram a importantes alterações no protótipo. O resultado dessas etapas gerou um programa com 3 módulos de psicoeducação. A terceira fase foi um ensaio com usuários, do qual participaram 21 sujeitos entre 19 e 55 anos. Os instrumentos utilizados foram o Y-BOCS, escalas subjetivas para avaliação da intensidade dos sintomas de TOC, humor e ansiedade, questões de usabilidade e log do programa. Os participantes levaram em média 8 dias para completar o programa, e o tempo médio de uso totalizou 2 horas e 14 minutos. Apenas uma questão dos quizzes teve frequência de acertos abaixo de 70%. O nível médio de satisfação foi de 8,33 no primeiro módulo, 8,71 no segundo e 9,00 no terceiro. Foi encontrada diferença nos escores obsessivos do Y-BOCS entre os dois momentos de avaliação e diferença estatisticamente significativa na escala subjetiva de sintomas do TOC entre os módulos 1 e 2, e 1 e 3. O programa obteve um bom nível de satisfação dos usuários e apresenta potencial efeito de redução de sintomas percebidos. O modelo de desenvolvimento do programa é aplicável a outros contextos em Psicologia e o protótipo desenvolvido pode ser utilizado como matriz para intervenções semelhantes. / This study presents the iterative process of creating, developing and evaluating a psychoeducational software addressed at Obsessive-Compulsive Disorder (OCD). In stage 1, an interative and self-administered prototype was created. Second stage consisted of evaluations with experts, which led to important changes in the prototype. The results of these steps generated a three-module psychoeducational software. Third stage was a usability trial with users, 21 participants, ranging from 19 to 55 years old. Measures used were Y-BOCS, subjective scales to assess OCD symptoms intensity, humor and anxiety, usability questions, and the system log. Participants took an average of 8 days to complete the intervention, and the average time of software usage was 2 hours and 14 minutes. Only one quiz question showed less than 70% correct answers. Mean level of satisfaction was 8,33 for the first module, 8,71 for the second and 9,00 for the third. A difference was found on obsessive scores of Y-BOCS at the two evaluation times, and a statistically significant difference was found on the scale of OCD symptoms intensity, between modules 1 e 2, and 1 and 3. The software reached a good level of satisfaction among users and shows a potential effect in reduction of perceived symptoms. The model of development may be used with other psychological applications, and the prototype may be used as a strucutral matrix for similar interventions.

O Transtorno de Ansiedade Social (TAS) consiste em um medo acentuado e persistente de situações sociais ou de desempenho nas quais o indivíduo poderia sentir vergonha. Dentre os transtornos de ansiedade, o TAS é um dos mais prevalecentes, sendo considerado o quinto transtorno mais incapacitante, contudo, a busca por tratamento é muito baixa. Diferentes estudos clínicos randomizados evidenciam que a TCCG apresenta resultados satisfatórios e duradouros, sendo considerada padrão ouro de intervenção para TAS, porém, ainda assim, uma parcela de pacientes com TAS não respondem ao tratamento. Assim sendo, o objetivo deste trabalho foi investigar o efeito de uma intervenção em grupo de exposição com alto custo social em pacientes com TAS sobre variáveis psicológicas e também sobre a qualidade de memória. A intervenção utilizada nesse estudo foi a proposta por Hofmann e Otto (2008). Dentre as variáveis psicológicas estudadas foram avaliadas mudanças em sintomas de ansiedade social, ansiedade, medo da avaliação negativa, esquiva e desconforto social, depressão e sintomas de transtornos psiquiátricos comuns. Participaram desse estudo 58 adultos, compondo três grupos experimentais diferentes: o grupo de comparação sem TAS, que consiste em participantes sem sintomas clínicos, o grupo de comparação com TAS, que são participantes portadores de TAS os quais não realizaram a intervenção durante a pesquisa (grupo lista de espera) e o grupo de portadores de TAS participaram da intervenção (grupo TCCG). Um pesquisador independente ao estudo realizou a distribuição aleatória dos participantes com TAS entre os grupos TCCG e lista de espera. Foram realizadas avaliações no pré e pós-teste através do Inventário de Fobia Social (SPIN), Inventários de Ansiedade e Depressão de Beck (BAI e BDI-II), Escala de Medo da Avaliação Negativa (FNE), Escala de Esquiva e Desconforto Social (SADS), Questionário sobre a saúde do paciente (PHQ-9), Questionário de Autorrelato (SRQ) e teste de falsas memórias. Assim, os resultados encontrados evidenciam que a intervenção alcançou redução significativa nos sintomas de ansiedade social, ansiedade geral, depressão e sintomas de transtornos mentais comuns, mostrando que foi uma intervenção efetiva. Além disso, os escores relacionados à ansiedade geral, depressão e sintomas de transtornos mentais comuns, após a intervenção foram equiparados com o escore obtidos pelo grupo de participantes saudáveis, evidenciando a excelente eficácia do processo de intervenção. A eficácia também pode ser constatada a partir da mensuração do tamanho de efeito grande encontrado no estudo relacionado ao principal instrumento de avaliação de TAS utilizado (SPIN), ou seja, esse estudo evidenciou que a forma psicoterápica utilizada atingiu o objetivo esperado da intervenção considerada padrão ouro. No que concerne às medidas relacionadas à qualidade de memória, a hipótese inicial relacionava-se à teoria de que os indivíduos ansiosos sociais apresentariam um número maior de falsas memórias e/ou uma redução de memórias verdadeiras, porém essa hipótese não foi confirmada. / Social Anxiety Disorder (SAD) consists of a marked and persistent fear of social or performance situations in which the individual could feel shame. Among the anxiety disorders, SAD is one of the most prevalent, considered the fifth most disabling disorder, however, the search for treatment is very low. Different randomized clinical trials show that Cognitive-Behavioral Group Therapy (CBGT) presents satisfactory and long-lasting results, which is considered the gold standard of intervention for SAD, however, a portion of patients with SAD do not respond to treatment. Thus, the objective of this study was to investigate the effect of a group intervention related to high social cost exposure in patients with SAD about psychological variables and memory quality. The intervention used in this study was proposed by Hofmann and Otto (2008). Among the psychological variables studied changes in symptoms of social anxiety, anxiety, fear of negative evaluation, avoidance and social discomfort, depression and symptoms of common psychiatric disorders were evaluated. Fifty-five adults participated in this study, composing three different experimental groups: the comparison group without SAD, which consists of participants without clinical symptoms, the comparison group with SAD, participants with SAD who did not receive intervention during the research (Waitlist control condition), and the group of SAD patients who participated in the intervention. An independent researcher to study distributed randomly the participants with SAD between CBGT or Waitlist condition. Assessments were made at pre and post-test using Social Phobia Inventory (SPIN), Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI-II), Fear of Negative Evaluation (FNE), Social Avoidance and Distress Scale (SADS), Patient Health-Questionnaire (PHQ-9), Self-Report Questionnaire (SRQ), and false memories test in the three groups. The results showed that the intervention achieved a significant reduction in the symptoms of social anxiety, general anxiety, depression and symptoms of common mental disorders, showing that it was an effective intervention. In addition, the scores related to general anxiety, depression and common mental disorder symptoms after the intervention were similar to the scores obtained by the group of healthy participants, evidencing the excellent efficacy of the intervention process. Efficacy can also be seen from the measurement of the large effect size found in the study evaluated by the main evaluation instrument of SAD used (SPIN), this study achieved the expected goal of the gold standard considered intervention. Concerning measures related to memory quality, the initial hypothesis was that social anxious individuals would present a greater number of false memories and / or a reduction of true memories, but this hypothesis was not confirmed.

Objetivo: Avaliar a resposta ao tratamento em longo prazo de pacientes com transtorno obsessivo-compulsivo (TOC) após cinco anos de terapia cognitivocomportamental em grupo (TCCG) ou sertralina 100mg/dia. Método: Em um estudo naturalístico foram acompanhados após cinco anos cinquenta pacientes que completaram 12 sessões semanais de duas horas de TCCG ou utilizaram 100mg de sertralina/dia pelo mesmo período. A intensidade dos sintomas foi avaliada cinco anos após o tratamento pela Yale-Brown Obsessive- Compulsive Scale (Y-BOCS), Impressão Clínica Global (CGI), Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI) e a qualidade de vida através do World Health Organization Quality of Life Assesment – Abreviated Version (WHOQOL-bref). Resultados: Tanto os pacientes tratados com TCCG como os tratados com sertralina apresentaram redução significativa na gravidade dos sintomas e manutenção dos ganhos terapêuticos cinco anos após o término do tratamento. Observamos também no período de seguimento um aumento no uso de medicação no grupo TCCG (p<0.001) e busca por atendimento psicoterápico no grupo que usou sertralina (p=0,084) embora este último em nível não significativo. Os resultados indicaram que 61,9% dos pacientes seguiram usando ou iniciaram o uso de medicamentos, e 41,5% iniciaram ou continuaram a TCC. Houve um aumento significativo de pacientes em remissão no grupo da sertralina (p=0,046), não ocorrendo o mesmo no grupo da TCCG (p=0,083). Houve aumento nos escores dos diferentes domínios da qualidade de vida independente do grupo. Conclusões: Nossos resultados demonstram que tanto o grupo que realizou TCCG como o que usou sertralina mantiveram a melhora alcançada logo após o término do tratamento, cinco anos após. Além disto, observou-se uma melhora em todos os domínios da QV. Talvez isso se deva ao fato de que mais da metade dos pacientes terem continuado em tratamento durante o seguimento. / Objective: Assess obsessive-compulsive disorder (OCD) patients' long term response to treatment after five years of cognitive-behavioral group therapy (CBGT) or sertraline 100mg/day. Methods: Fifty patients who completed 12 two-hour weekly CBGT sessions or had sertraline 100 mg/day for the same period were followed up in a naturalistic study. The severity of symptoms were evaluated after five years from the conclusion of treatment by Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), Clinical Global Impressions Scale - Severity underscore (CGI-S), Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), and quality of life with World Health Organization Quality of Life Assesment – Abreviated Version (WHOQOL-bref). Results: Both patients treated with CBGT and those treated with sertraline showed a significant reduction in the severity of symptoms and maintained therapeutic gains five years after the end of treatment. We also noticed an increase in the use of medication in the CBGT group (p<0.001) during the follow-up period and a search for psychotherapeutic treatment in the group who took sertraline (p=0.084), although this latter occurred at a non-significant level. Results indicated that 61.9% of patients continued using or started using the medication and 41.5% started or continued with the CBT. There was a significant increase of remissive patients in the sertraline group (p=0.046), while the same did not occur in the CBGT group (p=0.083). There was an increase in the scores of different quality of life domains (QL) regardless of the group. Conclusions: Our results showed that both the group that underwent CBGT and the one that took sertraline maintained their levels of improvement at the end of the five-year treatment. As well, an increase in all QL domains was noticed. Perhaps this may be put down to the fact that over half the patients continued with the treatment during the follow-up period.

While cognitive-behavioral therapy (CBT) is the most well-established treatment for binge-eating disorder (BED), little is known about process factors influencing its outcome. The present study sought to explore the assessment of therapist adherence, its course over treatment, and its associations with patient and therapist characteristics, and the therapeutic alliance. In a prospective multicenter randomized-controlled trial comparing CBT to internet-based guided self-help (INTERBED-study), therapist adherence using the newly developed Adherence Control Form (ACF) was determined by trained raters in randomly selected 418 audio-taped CBT sessions of 89 patients (25% of all sessions). Observer-rated therapeutic alliance, interview-based and self-reported patient and therapist characteristics were assessed. Three-level multilevel modeling was applied. The ACF showed adequate psychometric properties. Therapist adherence was excellent. While significant between-therapist variability in therapist adherence was found, within-therapist variability was non-significant. Patient and therapist characteristics did not predict the therapist adherence. The therapist adherence positively predicted the therapeutic alliance. The ACF demonstrated its utility to assess therapist adherence in CBT for BED. The excellent levels of therapist adherence point to the internal validity of the CBT within the INTERBED-study serving as a prerequisite for empirical comparisons between treatments. Variability between therapists should be addressed in therapist trainings and dissemination trials.

Submitted by Daniella Santos (daniella.santos@ufma.br) on 2017-09-12T14:52:30Z No. of bitstreams: 1 AnaCostaNeta.pdf: 757915 bytes, checksum: 3232fac494ac242711aca6433e3a9afc (MD5) / Made available in DSpace on 2017-09-12T14:52:30Z (GMT). No. of bitstreams: 1 AnaCostaNeta.pdf: 757915 bytes, checksum: 3232fac494ac242711aca6433e3a9afc (MD5) Previous issue date: 2017-05-25 / Mindfulness practices have been used in the treatment of clinical problems, for some time, with the use of the pioneer program of Kabat-Zinn, Mindfulness-based Stress Reductions (MBSR), program that served as a prototype for the development of other mindfulness-based, among them the of Segal, Williams and Teasdale, MindfulnessBased Cognitive Therapy (MBCT), which integrates mindfulness practices with strategies of Cognitive Therapy. From these integrations mindfulness practices have been inserted in the process of Cognitive Behavioral Therapy (CBT) increasingly, even the two clinical models showing-philosophical and theoretical principles of methods different interventions. Therefore, this study aimed to discuss how the theoretical fundaments of MBSR and CBT are integrated in MBCT, as well as possible reasons and implications of the inclusion of mindfulness strategies in CBT. For this we used articles available on the internet, books and chapters of books on the subject, in English, Portuguese and Spanish, without restriction to year of publication. The theoretical comparison was accomplished through four conceptions that supports the theoretical models: cognition, behavior, and environment of pathology. In addition, he likened himself, through the analysis of two sections, the interventions carried out in TCC and MBCT. Overall, they identified some similarities and compatibilities between the theoretical assumptions of CBT and MBCT, MBSR programs and being a significant difference how understand the cognitions, because while in TCC she is seen as deterministic and causal, MBSR programs and MBCT is just another mental event. It appeared also, controversies clear when one considers the classical cognitive model of Aaron Beck. / As práticas de mindfulness vêm sendo utilizadas no tratamento complementar de problemas clínicos, há algum tempo, com o uso do programa pioneiro de Kabat-Zinn, o Mindfulness-Basead Stress Reductions (MBSR), programa que serviu de protótipo para o desenvolvimento de outros baseados em mindfulness, dentre eles o de Segal, Williams e Teasdale, o Mindfulness-Based Cognitive Therapy (MBCT), que integra práticas de mindfulness com estratégias da Terapia Cognitiva. A partir dessas integrações as práticas de mindfulness vêm sendo inseridas no processo da Terapia CognitivoComportamental (TCC) de modo crescente, mesmo os dois modelos clínicos apresentando princípios teóricos-filosóficos e métodos de intervenções diferentes.Diante disso, este estudo objetivou discutir como os fundamentos teóricos do MBSR e da TCC são integrados no MBCT, bem como possíveis razões e implicações da inclusão de estratégias mindfulness na TCC. Para isso foram utilizados artigos disponibilizados na internet, livros e capítulos de livros sobre a temática, no idioma inglês, português e espanhol, sem restrição de ano de publicação. A comparação teórica foi realizada por meio de quatro concepções: cognição, comportamento, ambiente e visão de patologia. Além disso, comparou-se, por meio da análise de dois trechos de sessão, as intervenções realizadas na TCC e no MBCT. De modo geral, foram identificadas algumas semelhanças e compatibilidades entre os pressupostos teóricos da TCC e dos programas MBSR e MBCT, sendo a diferença significativa o modo como entendem as cognições, pois enquanto na TCC ela é vista como causal e determinista, nos programas MBSR e MBCT é apenas mais um evento mental. Verificou-se também, controvérsias claras quando se considera o modelo cognitivo clássico de Aaron Beck.

Objetivo: Construir um programa de Exposição à Realidade Virtual para tratar Fobia Social, avaliá-lo e aperfeiçoá-lo por meio de uma análise quantitativa e qualitativa. Método: Finalizaram o tratamento 21 sujeitos (11 homens e 10 mulheres) entre 18 e 63 anos diagnosticados pelo Manual Diagnóstico Estatístico de Transtornos Mentais 4a edição- texto revisado (DSM -IV- TR) para fobia social. Foram excluídos os sujeitos com depressão grave, com risco de suicídio, transtornos psicóticos e abuso de substância. Principais medidas de avaliação quantitativa: Escala de Ansiedade Social de Liebowitz - LSAS; Escala de Impressão Clínica Global - CGI; Escala para Incapacitação de Sheehan; Escala de Adequação Social - EAS; e Questionário de Pensamentos Automáticos - ATQ 30. Avaliação qualitativa: Questionário Metodológico Qualitativo de Avaliação de Ansiedade Social. Procedimento: as Escalas e os Instrumentos foram aplicados no pré-tratamento, no pós-tratamento e no seguimento após seis meses de tratamento. O Questionário Metodológico Qualitativo de Avaliação de Ansiedade Social foi aplicado no pós-tratamento. O tratamento consistiu em até 12 sessões de 50 minutos cada de exposição à Realidade Virtual. Resultados: Observou-se redução significativa no escore pós-tratamento que se manteve no seguimento, nas escalas que avaliaram ansiedade, fobia e disfunções cognitivas (LSAS, ATQ e EAS). Na CGI, houve redução na gravidade da doença após o tratamento e isto se manteve no seguimento. Os pacientes apresentaram melhora do transtorno que também se manteve no período do seguimento. A Escala de Incapacitação de Sheehan mostrou melhora significativa da vida profissional, social e familiar. O número médio de sessões para a diminuição da ansiedade social foi de 7. Conclusão: O tratamento utilizado neste estudo teve boa aceitação, boa adesão, auxilia na diminuição da ansiedade social como também no enfrentamento das situações temidas. Estudos controlados ulteriores deverão ser realizados para verificar se ratificam estes resultados preliminares / Objectives: To build a Virtual Reality Exposure software for the treatment of Social Phobia, to evaluate and improve it based on quantitative and qualitative analysis. Method: The treatment was completed by 21 subjects (11 men and 10 women) aged between 18 and 63, diagnosed with social phobia by the Diagnostic Statistical Manual of Mental Disorders 4th edition - revised text (DSM - IV-TR). Subjects were excluded on account of deep depression, suicide risk, psychotic disorders or substance abuse. The main measurement instruments for quantitative evaluation were: Liebowitz Social Anxiety Scale - LSAS, Clinical Global Impression Scale - CGI, Sheehan Disability Scale, Social Adjustment Scale - SAS, Automatic Thoughts Questionnaire - ATQ 30. Qualitative evaluation: Methodological Qualitative Questionnaire for the Evaluation of Social Anxiety. Procedure: The Scales and Instruments were applied in the pre-treatment and post-treatment phases and in the follow-up assessment six months after treatment. The Methodological Qualitative Questionnaire for the Evaluation of Social Anxiety was applied in the post-treatment phase. The treatment consisted of twelve 50-minute sessions of exposure to Virtual Reality. Results: A significant decrease in the score in scales that measure anxiety, phobia and cognitive dysfunctions (LSAS, ATQ and SAS) was observed after treatment and it was maintained on follow-up. Patients have shown improvement of the disorder that was also preserved on follow-up. The Sheehan Disability Scale has shown significant improvement in professional, social and family life. The average number of sessions to achieve a reduction of social anxiety was seven. Conclusion: The treatment used in this study has been well received; patients have shown adherence to it and it has helped them to reduce their social anxiety and deal with situations they feared. Further controlled trials should be undertaken to endorse these preliminary results

För att möta ett växande behov av tillgänglig hjälp för studiestressproblematik vid högskolor och universitet kan självhjälp som behandlingsform vara viktig att testa. I denna pilotstudie undersöktes effekten av deltagandet i ett textbaserat självhjälpsprogram utifrån kriterierna: perfektionism, prokrastinering, oro och livskvalitet, följsamhet och nöjdhet. Interventionen bestod av fem moduler för deltagarna att arbeta sig igenom under 5-7 veckor med minimal terapeutassistans. Nitton deltagare från ett universitet tackade ja till att delta i studien varav 11 inkom med såväl för- som eftermätningar.  Beroende t-test visade signifikanta skillnader mellan för- och eftermätning för utfallsmåtten prokrastinering (IPS (d=1.0)) och oro (GAD-7 (d=0.7)). För resterande utfallsmått för perfektionism (FMPS-PS, FMPS-CM) och livskvalitet (BBQ) uppvisades inga signifikanta skillnader. Följsamheten var låg, flertalet deltagare genomförde endast programmet till någon del. Uppfattningen fångades av CSQ-8 och visade att deltagarna till största delen var nöjda. Resultaten i pilotstudien ger argument för fortsatt studerande av självhjälp för studiestress och öppnar upp för en vidareutveckling av programmet i fokus, till exempel i form av en större kontrollerad studie med ökad terapeutassistans. / In order to meet a growing need for accessible support for student-related distress at universities, self-help as a treatment form may be important to test. This pilot study examined the effect of participation in a text-based self-help program based on the criterias: Perfectionism, Procrastination, Worry, Quality of Life, Compliance and Satisfaction. The intervention consisted of five modules for the participants to work through during 5-7 weeks with minimal therapist assistance. Nineteen participants from a university participated in the study, of which 11 handed in both pre- and post-measurement.Dependent T-tests showed significant differences between pre- and post-measurement for outcome measurement progression (IPS (d = 1.0)) and anxiety (GAD-7 (d = 0.7)). There were no significant differences for the remaining outcome measures for perfectionism (FMPS-PS, FMPS-CM) and quality of life (BBQ). The compliance was low, most of the participants only carried out the program to some extent. The level of satisfaction was captured by CSQ-8 and showed that the participants were mostly satisfied. The results of this pilot study provide argument for future study of self-help for student-related distress and opens up for further development of the program in focus, for example in the form of a larger controlled study with increased therapeutic assistance.

Tinnitus continues to challenge patients from all walks of life and clinicians from a variety of disciplines. The lack of an evidence base to support a specific treatment confounds efforts to provide consistent benefit to patients and in many instances creates in the patient the impression that nothing can be done to improve their situation. Part of the problem is that although patients rarely experience complete elimination of a tinnitus signal, they often experience relief when receiving effective counseling, specific coping strategies, and sound therapy. Although in most clinical activities the tinnitus remains (i.e., it is not cured), its influence may wane as the patient learns to manage their environment, activities, and ultimately their response to tinnitus. At the same time, several medical interventions target reduction of the tinnitus sound, an approach more consistent with what patients expect as a cure. Therefore, the majority of clinical activity directed at care for patients with tinnitus typically targets either elimination of the tinnitus sound (tinnitus treatment) or modification of the patient's response to the sound (tinnitus management). This review distinguishes and offers examples of both treatment and management programs employed clinically for patients with tinnitus.

The purpose of this study was to determine the effect of a single-session group music therapy songwriting session on grief processing in hospice clinicians. The study design was quasi-experimental. Participants were cluster randomized into a control group and a treatment group. The researcher led a 50-minute songwriting session focused on sharing and processing experiences of grief-related stress and burnout in hospice work. Grief processing was measured using a self-report survey for n=25. Overall differences between control and treatment groups were not found to be statistically significant. Significant differences were also not found in treatment score differences for type of hospice clinician or years of experience. For future research with hospice clinicians, a new measurement tool should be developed that is more specific to measuring an actual difference before and after a treatment. The current measurement tool is best used as an inventory for stress and grief levels that result from caregiving. Any new measurement tool should be kept under twenty questions. A single-session, though convenient for busy hospice clinicians, may not provide a complete treatment for grief and stress. Further research with hospice clinicians may require several treatment sessions to achieve a more complete grief processing experience.

Anxiety is a commonly diagnosed disorder in middle childhood that affects many aspects of the child’s life. Effective treatment is needed so that children are able to experience fewer or no symptoms of anxiety and to manage anxiety. Cognitive behavioral treatment (CBT) is widely used as a treatment for children with anxiety. CBT can either be facilitated in an individual or group format but there are inconsistencies in the literature regarding which modality is most effective. A meta-analysis was conducted to compare the effectiveness of individual CBT (ICBT) and group CBT (GCBT) in treating school-aged children with anxiety disorders. Eligible studies focused on the Coping Cat program for ICBT or GCBT programs such as FRIENDS. Participants from the selected studies were between the ages of 5-12 years and were treated by either ICBT or GCBT. Effect sizes were calculated from post-intervention measures and combined to examine group differences. It was found that ICBT was associated with a very large effect size (1.05) and GCBT (0.54) had a large effect size. This suggests that ICBT is the superior treatment modality as children who received individualized treatment reported a greater reduction or elimination of anxiety symptoms. Individual treatment allows opportunity for the therapist to work with the child and their families whereas in GCBT, there is less time to create treatment plans that are uniquely tailored. A proposed ICBT program is outlined that addresses a richer family component and social skills training.