Self-control instruction for children's fear-reduction

doi:10.1016/0005-7916(79)90067-3

Journal of Behavior Therapy and Experimental Psychiatry

Volume 10, Issue 3, September 1979, Pages 221-227

https://doi.org/10.1016/0005-7916(79)90067-3 Get rights and content

Abstract

Five boys and two girls, 8 to 12 years of age, with severe night time fears of long duration, participated with their parents in three instruction sessions of self-control training for home-based practice. The parents supervised, monitored and rewarded with praise and “bravery tokens” their children's self-control exercises practiced nightly before bed, i.e., (1) muscle relaxation; (2) imaging a pleasant scene, and (3) reciting special “brave” self-statements. The long-standing, highly resistant problems of night time fears were solved for all families. No newfears or other problems occurred over the three-month, six-month and one-year follow-ups.

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There are more references available in the full text version of this article.

Cited by (47)

Cognitive–behavioral versus non-directive therapy for preschoolers with severe nighttime fears and sleep-related problems
2017, Sleep Medicine
Citation Excerpt :
Nevertheless, intense fears of this nature are often associated with anxiety disorders and other psychiatric diagnoses [1]. The emotional implications of NFs may include impairment of the self-image and feelings of social embarrassment or isolation, due to avoidance of dark areas, refusal to visit friends or to sleep away from home [8]. Related sleep problems further augment this issue, as research has shown that sleep disturbances and insufficient sleep have deleterious effects on children's cognitive development, mood regulation, behavior, health and overall quality of life [9–11].
To compare the efficacy of a developmentally appropriate cognitive–behavioral therapy protocol for preschoolers with severe nighttime fears and sleep-related problems, with an active control treatment.
Ninety children aged four to six years (63% boys) with severe nighttime fears and their parents were randomized to either cognitive–behavioral therapy including parent involved play (CBT-PIP) or to a structurally equivalent non-directive treatment (TEPT; triadic expressive play therapy). Treatment conditions were also equivalent in parent- and child-rated credibility and expectancy, and in therapist-rated compliance. Children and parents were assessed at baseline, during the first intervention week and four weeks after treatment. Measures included actigraphy, daily sleep logs, structured diagnostic interviews and parent questionnaires.
Significant reductions were observed in nighttime fears and objectively and subjectively measured sleep disruptions in both intervention groups following treatment. Parent reports indicated more advantageous outcomes for CBT-PIP compared to TEPT, with greater reductions in sleep problems and co-sleeping as well as higher customer satisfaction in the former group.
While CBT-PIP showed no significant advantage compared to the active control in reducing fears or in improving objectively measured sleep, it was significantly more beneficial in reducing the adverse behavioral features of nighttime fears.
Treating nighttime fears in young children with bibliotherapy: Evaluating anxiety symptoms and monitoring behavior change
2015, Journal of Anxiety Disorders
Citation Excerpt :
Specific phobias are estimated to be present in about 10% of community samples of children and adolescents and up to 5% of referrals to outpatient centers (Kessler et al., 2005). Additionally, up to 15% of referrals for the treatment of childhood phobias are related to the dark and being alone in the dark (Graziano, Mooney, Huber, & Ignasiak, 1979). These fears can result in the child experiencing significant anticipatory anxiety preceding bedtime and having elevated fear and anxiety symptoms throughout the night and into the next day.
Children's nighttime fears are a normal part of child development and are transient for most children, but result in considerable distress for others. The present study evaluated a 4-week bibliotherapy intervention designed to treat young children with persistent and interfering nighttime fears utilizing a multiple baseline design.
Nine children between 5 and 7 years of age with specific phobia diagnoses were randomized into one of three baseline control conditions (1, 2, or 3 weeks). The treatment protocol involved parents reading Uncle Lightfoot, Flip that Switch: Overcoming Fear of the Dark, Academic Version (Coffman, 2012) with their children over 4 weeks while engaging in activities prescribed in the book. Assessments took place at baseline, post treatment, and 1 month following treatment. Daily and weekly tracking of nighttime behaviors was also obtained.
Pre-post group analyses revealed that eight of the nine children demonstrated clinically significant change in anxiety severity. In addition, decreases in child-reported nighttime fears were observed, as were parent-reported decreases in separation anxiety and increases in the number of nights children slept in their own bed.
The present study provides initial support for the use of bibliotherapy in the treatment of nighttime fears. Further replication and evaluation are needed to determine appropriate length of treatment and long-term effects. Implications of the findings are discussed.
A randomised controlled trial of cognitive-behaviour therapy for behavioural insomnia of childhood in school-aged children
2011, Behaviour Research and Therapy
Citation Excerpt :
However at this stage, dismantling treatment studies are needed to understand the specific mechanisms and therapeutic effects of each treatment component. A final difficulty is attempting to compare these findings to previous treatment studies, as conventional night-time sleep parameters have not been reported (Friedman & Ollendick, 1987; Graziano & Mooney, 1980, 1982; Graziano et al., 1979; King, Cranstoun, & Josephs, 1989). Instead, these studies reported various night-time behaviours similar to some insomnia symptoms.
Chronic sleep problems can lead to the development of Behavioural Insomnia of Childhood – a sleep disorder involving problematic sleep-onset associations (i.e., parental presence), and resulting in impairments for children and family members. The aim of the present paper was to perform a controlled evaluation of cognitive-behaviour therapy (CBT) for Behavioural Insomnia. 42 children (M = 9.3 ± 1.9 yrs, range 7–13 yrs, 18f, 24m) were randomised to CBT (N = 21) or waitlist control (N = 21). CBT consisted of 6 sessions, and combined behavioural sleep medicine techniques (e.g., sleep restriction) with anxiety treatment techniques (e.g., cognitive restructuring). Compared to waitlist controls, children receiving CBT showed significant improvements in sleep latency, wake after sleep onset, and sleep efficiency (all p ≤ .003), but not total sleep time (p > .05). CBT was also associated with a reduction in problematic sleep associations (p ≤ .001), child-reported total and separation anxiety (both p ≤ .01), with all gains being maintained 6 months post-treatment. This is the first controlled study to demonstrate that multi-component CBT can be effective for the sleep, insomnia, and anxiety symptoms of Behavioural Insomnia of Childhood in school-aged children. Future research is needed to ascertain active treatment components.
Treatment of children's nighttime fears: The need for a modern randomised controlled trial
2007, Clinical Psychology Review
Children's nighttime fears are common and cause significant interference to the child's functioning as well as causing much distress for the child and family. Therefore, effective and cost-efficient interventions are urgently needed by mental health professionals and counsellors. The authors review 29 studies, which investigated the efficacy of psychosocial treatment for children's nighttime fears. Most studies employed multiple baseline across subject designs or between group designs and most employed cognitive-behavioral techniques (i.e., desensitisation, emotive imagery, cognitive self-instruction, and reinforcement procedures). Although multi-method, informant assessments were not always conducted, in most studies rapid reduction of nighttime fears was typically achieved after only a few sessions with maintenance of gains. On the basis of our review, we make recommendations about assessment and intervention issues for the effective treatment of children's nighttime fears. Finally, future research directions are discussed including the need for a modern randomised clinical trial to more fully investigate treatment efficacy and the role of non-specific treatment factors.
Specific phobia
2005, Child and Adolescent Psychiatric Clinics of North America
Children's nighttime fears: Parent-child ratings of frequency, content, origins, coping behaviors and severity
2001, Behaviour Research and Therapy
Citation Excerpt :
A substantial proportion of children display nighttime fears (King, Ollendick & Tonge, 1997). Children with these fears become highly anxious through the night or when exposed to darkness (e.g., Graziano, Mooney, Huber & Ignasiak, 1979). Although it was originally thought that nighttime fears occurred predominantly in very young children (Friedman & Ollendick, 1989), recent research has shown that these fears are also reported frequently by older children.
The present study investigated nighttime fears in normal school children aged 4 to 12 yr (N=176). Children and their parents were interviewed about the frequency, content, origins, coping behaviors and severity of children's nighttime fears. Results showed that 73.3% of the children reported nighttime fears, indicating that these fears are quite prevalent. Inspection of the developmental course of nighttime fears revealed that these fears are common among 4- to 6-year-olds, become even more frequent in 7- to 9-year-olds and then remain relatively stable in 10- to 12-year-olds. Inspection of the origins of nighttime fears revealed that most of the children (i.e., almost 80%) attributed their fear to negative information; conditioning and modeling were endorsed less frequently (25.6% and 13.2%, respectively). A substantial percentage of the children (24.0%) indicated that learning experiences had not played a role in the acquisition of their nighttime fears. Children reported a variety of coping strategies in order to deal with their nighttime fears and generally rated these strategies as helpful in reducing anxiety. Furthermore, children's nighttime fears were associated with moderate levels of anxiety. Moreover, in about 10% of the children, nighttime fears were related to one or more DSM-III-R anxiety disorders. Finally, parental reports of children's nighttime fears substantially deviated from children's reports. Most importantly, parents provided a marked underestimation of the frequency of nighttime fears, at least as reported by their children.

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Self-control instruction for children's fear-reduction

Abstract

Phobias of childhood: Etiology and treatment

Psychol. Bull. (1975)