اثربخشی برنامه والد-کودک شناختی رفتاری بر اضطراب اجتماعی کودکان (مقاله علمی وزارت علوم)
درجه علمی: نشریه علمی (وزارت علوم)
آرشیو
چکیده
یکی از انواع اختلال های اضطرابی، اضطراب اجتماعی است که موجب مختل کردن عملکردهای تحصیلی، اجتماعی و خانوادگی می شود و اغلب اوقات سیر مزمنی را طی می کنند که ممکن است تا بزرگسالی ادامه یابد. هدف پژوهش حاضر سنجش اثربخشی برنامه والد کودک شناختی رفتاری بر اضطراب اجتماعی کودکان بود. جامعه موردپژوهش دانش آموزان پسر ابتدایی استان البرز شهرستان کرج بودند که نمونه گیری ابتدا به صورت خوشه ای چندمرحله ای انجام شد و سپس شش مدرسه به صورت تصادفی انتخاب شد. ابزارهای اندازه گیری مقیاس اضطراب اسپنس کودک و والد (1999)، مقیاس اضطراب اجتماعی لیبویتز (2003) بودند. 24 دانش آموز همراه با والد انتخاب شدند که نمره اضطراب اجتماعی آنها نزدیک خط برش بود و با هماهنگی مدرسه با این دانش آموزان پرسشنامه لیبویتز اجرا شد. گروه آزمایش، 13 جلسه درمانی را به صورت گروهی هفته ای یک بار دریافت کردند. طول مدت جلسات 90 دقیقه بود. یازده جلسه مختص کودک و والد و دو جلسه صرفاً برای والدین کودکان بود. نتایج تحلیل واریانس با اندازه گیری مکرر نشان داد برنامه والد کودک شناختی رفتاری بر اضطراب اجتماعی کودکان مؤثر است و ماندگاری اثر دارد (01/0> p ). براساس نتایج به دست آمده، پیشنهاد می شود از پروتکل درمانی طراحی و اعتباریابی شده در پژوهش حاضر برای کاهش اضطراب اجتماعی کودکان استفاده شود[1].The Effectiveness of Parent-Child Cognitive-Behavioral Program on Children's Social Anxiety
Social anxiety is one type of anxiety disorders which disrupts academic, social and family functions and often goes through a chronic course that may continue into adulthood. The aim of the present study was to measure the effectiveness of parent-child cognitive and behavioral program on children's social anxiety. The research population was primary school boys in Karaj city, Alborz province. Sampling was done through multi-stage clustering and six schools were randomly selected. Tools for measuring child and parent anxiety were Spence scale and social anxiety scale. Twenty-four students whose social anxiety score was close to the cut-off line were selected with their parents. Leibovitz's questionnaire was administered to students with the coordination of the school. The experimental group received 13 therapy sessions during 13 weeks. The results of repeated measures ANOVA showed that the parent-child cognitive and behavioral program is effective and has a lasting effect on children's social anxiety ( p <0.01). Based on the results, it is suggested to use the designed protocol to reduce children's social anxiety. Introduction: Social anxiety disorder is a common and distressing psychological disorder in social situations with an estimated twelve-month prevalence among children and adults ranging from 0.5 to 7% worldwide (Vente et al. 2022). According to the social cognitive behavioral model of social anxiety, a person's fear of negative evaluation may be the main factor leading to social anxiety (Heimberg et al. 2014; Ren & Li, 2020). Epidemiological research indicates that social anxiety disorder begins earlier than other anxiety disorders with an average age of 13 years old (Farrell, 2019). For people who struggle with social anxiety disorder, problems occur in all areas of life, including relationships, jobs, school attendances, and educational endeavor (Olson, 2021) associated with low quality of life, poor academic or professional performance and unemployment. This has a high co-morbidity with other psychiatric disorders including depression and other clinical disorders such as substance abuse (Vente et al. 2022; Pearcey et al. 2020). Hence, it highlights the need for effective early interventions based on a good understanding of what sustains social anxiety in children and adolescents (Halldorsson & Creswell, 2017). Cognitive behavioral therapy is effective for children and adolescents with social anxiety disorder and is considered the first treatment in clinical guidelines (Nordh et al. 2021). A recent meta-analysis of 11 studies reported statistically significant improvements in clinical and self-report measures of anxiety in response to cognitive behavioral therapy interventions (Bemmer et al. 2021). In order to take the next step in improving the outcome of treatment, there is a serious need to identify factors related to the success and failure of treatment, especially in children with social anxiety disorder (Klein et al. 2021). Hudson et al. (2015) showed in a research study that children with social anxiety compared to children with general anxiety are twice likely to remain in the initial diagnosis of social anxiety after receiving a general anxiety treatment protocol and 12 months of follow-up. Therefore, it is important to know why these children get less results from conventional cognitive-behavioral treatments. The meta-analysis of Brynholst colleagues (2012) showed that many studies lack a regular protocol to involve parents in the treatment of children (ost et al. 2015). Also, the research of Garcia-Lopez et al. (2014) showed that including parents in the treatment of children's social anxiety by emphasizing their emotional problems increases treatment results. Decades of research linking parenting and family variables to the cause and course of childhood anxiety disorders have led to repeated efforts to improve outcomes by involving parents in treatment. Therefore, it is necessary to identify and address the important parental variables that are involved in the child's social anxiety. Children spend half of their waking hours at school, where the impact of teacher and peer relationships can be critical to their psychological well-being. Therefore, in the field of prevention and treatment, schools have been used by psychological science researchers and specialists for many years as the most effective environment available for the effectiveness of interventions (Bernstein et al., 2008). Although the aforementioned studies show the positive effects of adding social skills training or cognitive components compared to the control group in reducing the social anxiety of young children, the results indicate that more efforts to improve the results is needed. The question of the current research is whether involving the family in the treatment of this group of children reduces the symptoms of social anxiety. Materials & Methods The current research was quantitative, a semi-experimental study with a pre-test-post-test and follow-up design with a control group seeking the question of whether family participation can reduce the symptoms of social anxiety in children. The target population included all students 8-12 years old in Alborz province who were studying in schools during the academic year 2017-2018. Sampling was first in the form of a multi-stage cluster in which six schools were randomly selected. After the introduction of 54 students by the teachers, a meeting was held for the parents of these students and they completed the child and parent Spence anxiety scale parent questionnaire. Then, according to the questionnaire that the parents had completed, 24 students were selected along with their parents whose social anxiety score was close to the cut-off line, and with the coordination of the school, Liebowitz 's social anxiety questionnaire was administered to them. After developing the treatment protocol, Lawshe’s method was used to determine its content validity, which was graded with 1 being the weakest and 10 being the best. The results could be obtained from their sum and average. To evaluate the prepared protocol, the content of the protocol was provided to five experts. The total score of 9.15 out of 10 showed the agreement coefficient of the judges regarding the content validity of the designed package. Measurement tools Liebowitz Social Anxiety Scale: This scale has 24 items. The subject answers the questions on a 4-point Likert scale. Child and Parent Spence Anxiety Scale: Spence's anxiety scale consists of 45 items. Scoring is based on a 4-point Likert scale. The experimental group received 13 therapy sessions as a group once a week. Each session lasted for 90 minutes. Eleven sessions were for children and parents and two sessions were only for parents of children. Result The subjects studied in this research were boys. Descriptive results showed that the mean and standard deviation of the age of the subjects in the experimental group were equal to 9.67 and 0.98, respectively, and the mean and standard deviation of the age of the subjects in the control group were equal to 1.10 and 1.18, respectively. The results obtained from the multivariate covariance analysis (MANCOVA) showed that the difference between the groups (experimental and control groups) in the subscales of social anxiety is statistically significant (P<0.01). Therefore, it is possible to accept the decrease in the scores of children's social anxiety scales in the post-test. The Shapiro-Wilk test was used to check the normality of the data, and since the significance level of the Shapiro-Wilk test for the research variables was more than 0.05, it can be concluded that the research data are normal. Levene's test was used to check the assumption of equality of variance. In this test, the significance level of the research variables is more than 0.05, which indicates the equality of the variance of the research variables. Table 1. Means of Reducing Children's Social Anxiety in the Pre-Test and Follow-Up in the Study Groups Test Experiment Control Mean SD Mean SD Pre-test 54/00 6/223 60/18 8/232 Follow-up 47/42 3/630 66/36 6/136 Also, the results obtained from the repeated measures ANOVA analysis and the intergroup test showed the permanence of the reduction scores of children's social anxiety in the experimental and control groups. The results of the repeated measures showed that the difference between the social anxiety reduction scores of children in the pre-test and follow-up is statistically significant ( p <0.01). Therefore, it can be accepted that there is a difference between the groups (experimental group and control group) in the pre-test and follow-up in reducing the scores of children's social anxiety. Results and discussion In the present study, the effectiveness of parent-child cognitive behavioral program on children's social anxiety was investigated. The results showed that the cognitive and behavioral program (mother-child) is effective in reducing children's social anxiety and has a lasting effect. The results of this finding are consistent with the researches of Nordh et al. (2021). This program teaches the nature of anxiety and understanding children's social anxiety through visual training of thoughts, emotional training, reducing physiological arousal, identifying negative spontaneous thoughts, replacing positive thoughts, increasing social skills, realistic thinking and realistic facing of fears which helps parents to consciously and correctly help to solve and control their children's social anxiety. Another positive aspect of parents' presence in this program is that parents play an important role in the treatment of children with anxiety disorders because they are in the best position to teach their children adaptive responses (Shahni et al., 2017). Another significant factor that seems to have had an effect on the effectiveness of this protocol was the participation of teachers and the implementation of the program in the school, which makes the treatment program more effective. The study sample was only boys and it was not possible to examine gender differences in this study. Considering that our community was Alborz province and more research is needed in other regions with clinical populations and different levels of anxiety in order to examine the results of these groups, therefore caution should be taken in generalizing the results of this research. Future researchers are suggested to investigate the effectiveness of this treatment model with children with different levels of social anxiety (low, moderate and severe). Since the role of relationships with peers is important in creating and maintaining symptoms of social anxiety, it is recommended to develop protocols with this factor and check their effectiveness. Several variables play a role as mediators in influencing social anxiety, it is suggested that such variables such as attachment, mood, and behavioral inhibition are investigated in future studies. The prepared protocol can be used in psychological clinics for children with social anxiety. The content of this educational program can be used individually and in school groups.
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