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

Visagie, Lisa S. (2016-12)

Thesis (PhD)--Stellenbosch University, 2016.

Thesis

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.

AFRIKAANSE OPSOMMING: Angs is die mees algemene sielkundige probleem wat deur kinders en adolessente gerapporteer word. Angs is selfs meer algemeen by kinders met visuele gestremdhede. Indien angssimptome aanwesig is en nie behandel word nie, mag dit negatiewe gevolge hê. Dit is egter belowend dat kognitiewe gedragsterapeutiese intervensies suksesvol bewys is vir die behandeling van angs by kinders. Die meeste angsintervensie programme, gebaseer op kognitiewe gedragsterapie, is vanweë die inhoud daarvan (byvoorbeeld tekenprentjies, inkleurprentjies, werkboeke en visueel-gebaseerde aktiwiteite) egter nie toeganklik vir hierdie spesifieke populasie van kinders met visuele gestremdhede nie. Die huidige studie is dus gemotiveer deur die gebrek aan navorsing oor hierdie onderwerp en het die ontwikkeling, implementering en evaluering van ʼn angsintervensieprogram wat spesifiek op Suid-Afrikaanse kinders met visuele gestremdhede toegespits is, ten doel gehad. Daar is van ‘n toevallige waglys- kontrolegroepontwerp met pre-, post-, en opvolg -intervensiemaatreëls gebruik gemaak. Die angsintervensieprogram (PAM program) is geïmplementeer met ‘n finale steekproef van 52 instemmende kinders (tussen die ouderdommevan 9-13 jaar), met verskeie grade van visuele gestremdhede, verbonde aan twee spesiale skole in die Wes-Kaap. Die deelnemers by elk van die twee skole is toevallig toegedeel tot ʼn onmiddellike intervensiegroep (IIG) (n=27) en ʼn uitgestelde intervensiegroep (DIG) (n=25). Die deelnemers is oor ʼn tydperk van tien maande opgevolg waartydens hulle angssimptome oor die tyd by vier toetstydgeleenthede (T1-T4) kwantitatief geassesseer is. Die deelnemers het ʼn kort biografiese vraelys sowel as twee angsmeetmiddels, insluitende die 30-item Revised Child Anxiety and Depression Scale (RCADS-30) en die Penn State Worry Questionnaire for Children (PSWQ-C) voltooi. Die voltooiïngsproses van hierdie vraelyste is aangepas in ooreenstemming met die betrokke deelnemer se graad van visuele gestremdheid. Kwalitatiewe data met betrekking tot die toeganklikheid en die uitvoerbaarheid van die PAM program is ook ingesamel. In teenstelling met die verwagting wat die hoofuitkomste meting betref, het aanvanklike statistiese resultate aangedui dat die PAM program nie ʼn beduidende vermindering in angssimptome binne die steekproef van kinders met visuele gestremdhede tot gevolg gehad het nie. Meer spesifiek, tellings wat angsvlakke volgens die RCADS-30 en die PSWQ-C aandui, het deurgaans onbeduidende uitkomste gelewer, aangesien beduidende effekte nóg tussen-groep, nóg binne-groep aangeteken is vir die onmiddellike intervensiegroep (n=27) of die uitgestelde intervensiegroep (n=25) by enige van die vier toetstydgeleenthede (T1-T4). Hoewel die verlangde intervensie effekte nie verkry is nie, het die program egter belofte getoon wat voorkomende effekte betref, aangesien geen deelnemers wat sub-kliniese angssimptome by T1 aangedui het, tot binne die kliniese skaalwydte beweeg het teen T4 nie. Dus, hoewel dit nie statisties bepaal is nie, blyk dit dat blootstelling aan die PAM program ʼn verergering van angssimptome voorkom het. Die kwalitatiewe data het getoon dat beide die deelnemers (N=52) en die navorsingsfasiliteerders (n=3) die PAM program se toeganklikheid as aanvaarbaar beskou het. Dit blyk dat dit wel uitvoerbaar was om die PAM program aan te bied by beide die twee skole. Goeie infrastruktuur, dissipline, organisasie en roetine speel egter ‘n belangrike rol om die implementering van die program heelwat te vergemaklik. Ter afsluiting word ʼn kritiese oorsig oor die studiegebied asook aanbevelings vir toekomstige navorsing gemaak.

Please refer to this item in SUNScholar by using the following persistent URL: http://hdl.handle.net/10019.1/100110
This item appears in the following collections: