Table 1 Core Functions and Forms [76] for Coping Cat

STAGE 1

Core Function 1: “Build a Collaborative Working Alliance”

Psychoeducation: to develop a shared conceptualization of the tasks and goals of therapy, patients and their families are provided with age-appropriate written materials (as part of the CC manual), and the therapist engages them in discussion about how anxiety can develop and be maintained, and how it can be treated.

Collaborative exercises: a range of forms are provided to allow therapists to engage in collaborative activity to develop a working alliance. Therapists have flexibility with fidelity to customize the development of the coping FEAR plan (e.g., use of which self-statements) and exposure hierarchy (fear focus, size of steps, timing, use of in vivo vs imaginal exposures). Level of parent and level of youth input into these tasks can be customized to accomplish this core function.

Clinician Relatedness: through training procedures and supervisory review of videorecordings of patient sessions, supervisors will identify what changes are needed in the clinician’s behavior to optimize empathy and ability to work with the patients collaboratively and in an age-appropriate way; those changes will be modeled by the supervisor, then role-played with the supervisor, who will observe further session recordings to ensure that the appropriate clinician behaviors are established.

Core Function 2: “Exposure without Avoidance”

Exposure Tasks: multiple sessions of CC are devoted to experiences designed by the therapist in collaboration with the patient, in which the patient is exposed to specific stimuli in the patient’s anxiety hierarchy over time and across successive occasions. Through these experiences the patient learns that the feared stimuli or situations that have been avoided can actually be tolerated, increasingly so, and that feared consequences do not actually occur. The form of these exposures is intended to vary from patient to patient in terms of fear focus, size of steps, timing, use of in vivo vs imaginal exposures and the function may be accomplished by any of these variants.

Core Function 3: “Develop Coping Efficacy”

The CC manual provides a wide variety of tools to enhance youths’ and parents’ sense of coping efficacy and the patient’s resulting ability to tolerate and manage negative affect. While all families are provided information and training on all of these tools, the coping FEAR plan may take different forms across patients. It is designed to highlight the tools youths have found most helpful over the course of care. The forms below indicate the range of tools that may be included on the plan in order to accomplish the core function of developing coping efficacy, grouped by domain.

Somatic Management: tools are provided for identification of somatic cues of anxiety, diaphragmatic breathing, and progressive muscle relaxation. Customization of these exercises is acceptable and expected (e.g., which muscle groups to highlight). Handouts and therapist scripts are available and may be repeated as necessary.

Cognitive Restructuring: tools are provided to identify thoughts, challenge distorted thinking, analyze automatic thoughts, develop positive self-talk, and enact coping scripts. Handouts and therapist scripts are available and may be repeated as necessary.

Problem Solving: a problem-solving framework is introduced through therapist scripts, handouts, and in-session activity to provide a rubric to evaluate specific actions for dealing with problems (one homework task to “Show That I Can” (STIC) is assigned each week).

Core Function 4: “Engage in Reward”

Self-monitoring and Reinforcement: through practice in session, the therapist teaches the child to monitor and evaluate/rate his or her own behavior and to reward self for the effort.

STAGE 2

Core Function 5: “Intensification” Continue progression through, and intensification of, exposure

The therapist continues to guide the patient through the patient’s hierarchy to tasks involving the highest levels of difficulty. This is the intensified analogue of Stage 1 Core Functions 2 and 3.

Core Function 6: “Consolidation” Consolidate and review previously learned CBT coping skills

Continue practice of learned coping skills.

Review accomplishments and rewards.