Take Action is built upon a large body of research and practice evidence that indicates anxiety disorders in childhood can be successfully treated with Cognitive Behavioural Therapy (CBT). Most CBT programs typically address the physiological (e.g. somatic symptoms), cognitive (e.g. negative, threat-related thoughts), and behavioural processes (e.g. avoidance) which are thought to cause and maintain anxiety in children. CBT enables children to identify their anxiety and to apply skills to gradually approach anxiety-provoking situations. More specifically such interventions include:
- Psycho-education about anxiety.
- Somatic management of physiological symptoms.
- Cognitive restructuring (i.e., developing realistic expectations and coping self-talk).
- Graded exposure to anxiety-provoking situations.
- Problem solving skills.
- Social skills training (e.g. assertiveness).
- Relapse prevention and maintenance of skills.
Take Action includes the above CBT components and also integrates treatment techniques derived from recent advances in the threat-based cognitive biases and maladaptive thinking styles of anxious children. Over 550 children have participated in the Take Action Program since 2004 in individual or group formats. Excellent results have been found with 60–80% of children diagnosis free at the end of the group program. Ongoing research into the factors that influence outcomes from CBT programs for child anxiety disorders, such as the Take Action program, is a major focus of ongoing research by the authors, Dr Allison Waters and Dr Trisha Groth (nee Wharton in the publications listed below).
Research Publications Involving Take Action
(as of June 2017)
Studies demonstrating the clinical benefits of the Take Action Program:
1. Waters, A. M., Wharton, T. A., Zimmer-Gembeck, M. J., & Craske, M. G. (2008). Threat-based cognitive biases in anxious children: Comparison with non-anxious children before and after cognitive-behavioural treatment. Behaviour Research & Therapy. 46, 358-374.
Demonstrates the clinical benefits of the Take Action program in reducing anxiety in a group of children between 8 and 12 years of age. One of the first published papers to show how group CBT (i.e., the Take Action Program) leads to reductions in specific cognitive mechanisms involved in the development and maintenance of anxiety disorders.
2. Waters, A. M., Ford, L. A., Wharton, T. A., & Cobham, V. E. (2009). Cognitive behavioural therapy for young children with anxiety disorders: Comparison of group-based child + parent versus parent only focused treatment. Behaviour Research & Therapy. 47, 654-662.
One of the first published trials to show that delivering group CBT via the Take Action program to parents only of young anxious children between 4 and 7 years of age is as effective in reducing childhood anxiety as delivering treatment with parents and children.
3. Waters, A. M., Donaldson, J., & Zimmer-Gembeck, M. J. (2008). Cognitive behavioural therapy combined with an interpersonal skills component in the treatment of generalized anxiety disorder in adolescent females: A case series. Behaviour Change. 25, 35-43.
A pilot case series study delivering the Take Action program combined with an interpersonal skills component with teenage girls. Demonstrates the benefits and application of the Take Action program for targeting anxiety concerns in adolescents.
4. Waters, A. M. Mogg, K., & Bradley, B. P. (2012). The direction of threat attention bias predicts treatment outcome from cognitive behavioural therapy in anxious children. Behaviour Research & Therapy. 50, 428-424.
Translates research on threat attention bias into clinical practice by being one of the first published papers to show that the direction of children’s threat attention bias at pre-treatment influences clinical outcomes following group delivery of the Take Action program by trained psychologists.
5. Waters, A. M., Groth, T. A., Sanders, M., & O’Brien, R, & Zimmer-Gembeck, M. J. (2015). Developing partnerships in the provision of youth mental health service delivery and clinical education: A school-based cognitive behavioural intervention targeting anxiety symptoms in children. Behavior Therapy. 46, 844-855.
Demonstrates the utility of delivering the Take Action program to classes of school-age students by provisionally registered psychologists practicing under supervision of a trained clinical psychologist. Demonstrates beneficial outcomes in terms of reducing anxiety symptoms and improving threat-based interpretation biases in classes of students receiving the intervention in comparison to classes completing the standard curriculum.
6.Waters, A. M., Potter, A., Jamesion, L., Bradley, B. P., & Mogg, K. (2015). Predictors of treatment outcome in anxious children receiving group-based cognitive behavioural therapy: Pre-treatment attention bias for threat and emotional variability during exposure tasks. Behaviour Change. 32, 143-158.
One of the first studies to incorporate within-session and between-session exposure tasks into a small group format the Take Action Program when the treatment and within-session exposure tasks were delivered by trained psychologists.
7. Waters, A. M., Groth, T. A., Purkis, H., & Alston-Knox, C. (2017). Predicting outcomes for anxious children receiving cognitive-behavioural therapy: Does type of diagnosis make a difference? Clinical Psychologist.doi:10.1111/cp.12128
Examined children's treatment outcomes following group-based CBT (take Action) as a function of type of principal anxiety disorder: social phobia (SocP), separation anxiety disorder (SAD), generalised anxiety disorder (GAD), specific phobia (SP). Children with a principal diagnosis of SocP and GAD had poorer post-treatment outcomes compared to children with a principal diagnosis of SP and SAD. Poorer outcomes persisted in children with a principal diagnosis of SocP by the follow-up assessment compared to children with the other anxiety disorders.
Other Related Research Publications
7. Craske, M. G., & Waters, A. M. (2005).Panic disorder, phobias, and generalized anxiety disorder. In S. Nolen-Hoeksema, T. Cannon, T. Widiger, T. Baker, S. Luthar, S. Mineka, R. Munoz, & D. Salmon (Eds.). Annual Review of Clinical Psychology, 1, 197-225.
8. Waters, A. M. & Craske, M. G. (2005). Generalised anxiety disorder. In M. M. Antony, D. R. Ledley, & R. G. Heimberg, (Eds). Improving outcomes and preventing relapse in cognitive behavioral therapy. (pp. 77-127). New York: Guilford.
9. Waters, A. M., Craske, M. G., Bergman, R. L., & Treanor, M. (2008). Threat interpretation bias as a vulnerability factor in childhood anxiety disorders, Behaviour Research & Therapy. 46(1), 39-47.
10. Waters, A. M., Henry, J., & Neumann, D. L. (2009). Aversive Pavlovian conditioning in childhood anxiety disorders: Impaired response inhibition and resistance to extinction, Journal of Abnormal Psychology, 118(2), 311-321.
11. Waters, A. M., Farrell, L. J., & Schilpzand, E. (2013). Neuropsychological assessment and clinical intervention for youth with anxiety disorders. In L.A. Reddy, A.Weissman., & J.B., Hale (Ed.), Neuropsychological assessment and intervention for youth: An evidence-based approach to emotional and behavioral disorders. American Psychological Association Press: Washington DC. pp. 13-40.
12. Waters, A. M., Zimmer-Gembeck, M. J. & Farrell, L. J. (2012).The relationships of child and parent factors with anxiety symptoms in children? Parental anxious rearing as a mediator. Journal of Anxiety Disorders.27, 737-745.
13. Waters, A. M., Bradley, B. P., & Mogg, K. (2014). Biased attention to threat in paediatric anxiety disorders (generalized anxiety disorder, social phobia, specific phobia, separation anxiety disorder) as a function of “distress” versus “fear” disorder categorization. Psychological Medicine. 44, 607-616.
14. Waters, A. M., Nazarian, M., Mineka, S., Zinbarg, R., Griffiths, J. W., Naliboff, B., Ornitz, E. M., & Craske, M. G. (2014). Preliminary evidence of differences in startle modulation as a function of principal fear versus distress disorders in adolescents. Psychiatry Research. 217, 93-99.
15. Waters, A. M., & Kershaw, R. (2015). Direction of threat attention bias is related to fear acquisition and extinction in anxious children. Behaviour Research & Therapy. 64, 56-65.
