The efficacy of “Coping Cat” cognitive-behavior therapy on somatic complains of girls and boys with anxiety and depression disorders

Document Type : Original Article


Aim: Investigating the efficacy of "Coping Cat Protocol" on somatic complains of girls and boys with anxiety and depression disorders and comorbidity of them.
Methods: The experimental method was performed via two stages of pre and post-test.
Sample group consisted of 80 (40 females and 40 males) third through fifth grades primary school students who were diagnosed to have anxiety disorders, depression or comorbidity with clinical interview based on DSM and somatic complains based on Child Behavior Checklist (CBCL) of Achenbach System of Empirically Based Assessment (ASEBA; Achenbach and Rescorla, 2001). The participants randomly assigned to two equally experimental and control groups. The experimental group received 16 individual therapy sessions. The post-test means of two groups were compared using analysis of covariance.
Results: The results indicated that somatic complains were significantly decreased in experimental group, and these results were reliable after 6 months of follow up, while gender was not effective in pre-test comparing to post-test results.
Conclusion: Importance of cognitive-behavior therapy based on Coping Cat Program on anxiety and depression disorders and comorbidity of them in children was salient.


  1. آشنباخ، ت. و رسکورلا، ل. (1384). کتابچه راهنمای فرمهای سن مدرسه نظام سنجش مبتنی بر تجربه آشنباخ (ASEBA)، ترجمه الف. مینایی. تهران: پژوهشکده کودکان استثنایی ( تاریخ انتشار اثر به زبان اصلی: 2001).
  2. بلالی، رقیه.، آقایوسفی، علیرضا. (1390). اثربخشی برنامه آموزش والدین بر کاهش مشکلات رفتاری کودکان. فصلنامه روانشناسی کاربردی. زمستان،4 (پیاپی 20): 73-59.
  3. دادستان، پریرخ؛ طهرانی زاده، مریم؛ کاظم زاده طباطبائی رسول ؛ آزادفلاح، پرویز؛ فتحی آشتیانی، علی (1389). اثربخشی برنامة درمانگری مقابله ای کت در کاهش نشانه های درونی سازی شدة کودکان ایرانی، فصلنامه روان شناسان ایرانی ، سال هفتم، شماره 28.
  4. طهرانی زاده، مریم. (1389). اثربخشی برنامه درمانگری کندال بر راهبردهای مقابله ای کودکان ایرانی مبتلا به اختلالهای درونی‌سازی شده، پایان نامه دکترای تخصصی روانشناسی، دانشکده علوم انسانی، دانشگاه تربیت مدرس.
  5. مشهدی، علی.، سلطانی شال، رضا.، میردورقی، فاطمه.، بهرامی، بتول. (1391). ویژگی های روانسنجی مقیاس چندبعدی اضطراب کودکان. فصلنامه روانشناسی کاربردی. بهار،4 (پیاپی 21): 87-70.
  6. Achenbach, T. M., & Rescorla, L. A. (2001). ASEBA school age forms profiles. Burlington, VT: University of Vermont, Research Center for Children, Youth & Families.
  7. American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed.), text revision. Washington, D.C: Author.
  8. Austin, J. K., Dunn, D. W., Caffery, H. M., Perkins, S. M., Harezlak, J. & Rose, D. F. (2001). Recurrent seizures and behavioral problems in children with first recognized seizures: A prospective study. Journal of Epilepsia. 43(12), 1564-73.
  9. Barrett, P. M., Ollendick, E. H. (2004). Handbook of interventions that work with children and adolescents: prevention and treatment, Chichester, UK: Wiley.
  10. Beidel, D. C., Christ, M. G., Long, P.J., (1991). Somatic complaints in anxious children. Journal of Abnormal Child Psychology, 19, 659–670.
  11. Bekhuis, E. Boschloo , L. Rosmalen , G.M. Schoevers, R. A (2015). Differential associations of specific depressive and anxiety disorders with somatic symptoms. Journal of Psychosomatic Research, 78 (2), 104-111.
  12. Bell-Dolan, D., Last, C. G., & Strauss, C. C. (1990). Symptoms of anxiety disorders in normal children. Journal of the American Academy of Child & Adolescent Psychiatry, 29, 759–765.
  13. Campo, J. V., Bridge, J., Ehmann, M., Altman, S., Lucas, A., Birmaher, B. & Brent, D. A. (2004). Recurrent abdominal pain, anxiety, and depression in primary care. Pediatrics, 113, 817–824.
  14. Colman,I., Wodsworth, M. E. J. Croudace, , T. J. , & Jones, P. B. (2007). Forty-year psychiatric outcomes following assessment for Internalizing disorder in adolescence. The American Journal of Psychiatry, 164, 126-133.
  15. Compton, S. March, J., Brent, D., Albano, A., Weersing, R., Curry, J. (2004). Cognitive behavioral psychotherapy for anxiety and depressive disorders in children and adolescents: an evidence based medicine review. American academy of child and adolescent psychiatry, 43(8), 930-959.
  16. Costello EJ, Angold A (1995) Epidemiology. In: March JS (ed), Anxiety disorders in children and adolescents. Gilford, New York, pp 109–124.
  17. Costello, E. J., Mustillo, S., Erkanli, A., Keeler, G., & Angold, A. (2003). Prevalence and development of psychiatric disorders in childhood and adolescence. Archives of General Psychiatry, 60, 837-844.
  18. Dhossche D, Ferdinand R, van der Ende J, Verhulst F (2001). Outcome of self-reported functionalsomatic symptoms in a community sample of adolescents. Annual Clinical Psychiatry, 13, 191–199.
  19. Dorn, L., Campo, J. V., Thato, S., Dahl, R., Lewin, D., Chandra, R., & Di Lorenzo, C. (2003). Psychological comorbidity and stress reactivity in children and adolescents with recurrent abdominal pain and anxiety disorders. Journal of the American Academy of Child & Adolescent Psychiatry, 42, 66–75.
  20. Egger, H. L., Costello, E. J., Erkanli, A., & Angold, A. C. (1999). Somatic complaints and psychopathology in children and adolescents: Stomach aches, muscular-skeletal pains and headaches. Journal of the American Academy of Child and Adolescent Psychiatry, 38, 852-860.
  21. Eisen AR, Engler LB (1995). Chronic anxiety. In: Eisen AR, Kearney CA, Schaefer CE (eds) Clinical handbook of anxiety disorders in children and adolescents. Jason Aronson, Lanham, MD, pp 223–250.
  22. Essau, C. A., Conradt, J. & Peterman, F (2002). Frequency, comorbidity and psychosocial impairment of specific phobia in adolescents. Journal of clinical child psychology, 29(2), 221-231.
  23. Gerrits, M. J. G. van Marwijk, W.J. van Oppen, P, van der Horst, H. & Penninx, B. (2013).The role of somatic health problems in the recognition of depressive and anxiety disorders by general practitioners. Journal of Affective Disorders, 151(3), 341-348.
  24. Ginsburg, G. S., Riddle, M. A., & Davies, M. (2006). Somatic symptoms in children and adolescents with anxiety disorders. Journal of the American Academy of Child and Adolescent Psychiatry, 45, 1179-1187.
  25. Hofflich, S. A., Hughes, A. A., & Kendall, P. C. (2006). Somatic complaints and childhood anxiety disorders. International Journal of Clinical and Health Psychology, 6, 229-242.
  26. Hudson, J. , Deveny, C. ,& Taylor, L.(2005). Nature, assessment and treatment of general anxiety disorder in children. Pediatric annals, 34(2),97-106.
  27. Husain, K., Browne, T., & Chalder, T. (2007). A review of psychological models and interventions for medically unexplained somatic symptoms in children. Child and Adolescent Mental Health, 12, 2–7.
  28. Kazdin, A. E., & Weisz, J. R. (1998). Identifying and developing empirically supported child and adolescent treatments. Jounal of Consulting and Clinical Psychology,66 (1), 19-36
  29. Kendall, P. C. & Hedtke, M. A. (2006). Cognitive Behavior Therapy for Anxious Children, therapist manual (third edition). Ardmore, PA, workbook publishing.
  30. Kendall, P. C. (1994). Treating anxiety disorders in children: Results of a randomized clinical trial. Treatment of Anxiety Disorders in children: long term (6 years) follow up. Journal of Consulting and Clinical Psychology, 69, 135-141.
  31. Kendall, P. C., Safford, S. Flannery-Schroeder, E., & Webb, A. (2004). Child anxiety treatment: Outcomes in adolescence and impact on substance use and depression at a 7 year follow-up. Journal of Consulting and Clinical Psychology, 72, 276–287.
  32. Koby D. G. (2008). Somatic Symptoms in Adult Anxiety Disorders and Response to Cognitive Behavioral Therapy, University of Connecticut, A Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy, University of Connecticut.
  33. Last CG (1991). Somatic complaints in anxiety disordered children. Journal of Anxiety Disorders, 5, 125–138.
  34. Laura C. Reigada, Paige H. Fisher, Cynthia Cutler, Carrie Masia Warner (2008). An Innovative Treatment Approach for Children with Anxiety Disorders and Medically Unexplained Somatic Complaints. Cognitive and Behavioral Practice, 15, 140–147.
  35. Lewinsohn, P. M., Hops, H., Roberts, R. E., Seeley, J. R., & Andrews, J.A.(1993). Adolescent psychopathology: I. Prevalence and incidence of depression and other DSM-III-R disorders in high school students. Journal of Abnormal Psychology, 102, 133–144.
  36. Lipsitz, J. S., Masia-Warner, C., Apfel, H., Marans, Z., Hellstern, B., Forand, N. & Fyer, A. J. (2004). Anxiety and depressive symptoms and anxiety sensitivity in youngsters with noncardiac chest pain and benign heart murmurs. Journal of Pediatric Psychiatry, 29, 607–612.
  37. Masi, G., Favilla, L., Millepiedi, S., Mucci, M. (2000). Somatic symptoms in children and adolescents referred for emotional and behavioral disorders. Psychiatry: Interpersonal Biological Processes, 63:140–149.
  38. Masia Warner, C., Colognori, D., Kim, R. E., Reigata, L. C., Klein, R. G., Browner-Elhanan, K. J., et al. (2011). Cognitive-behavioral treatment of persistent functional somatic complaints and pediatric anxiety: an initial controlled trial. Depression and Anxiety, 0, 1-9.
  39. Ollendick, T. H., King, N. J., & Chorpita, B. F. (2006). Empirically supported treatments for children and adolescents. In P. C. Kendall (Ed.), Child and adolescent therapy. New York: Guilford Press.
  40. Pine, D. S., Cohen, P., Gurley, D., Brook, J. , & Ma, Y.(2003). The risk for early adulthood anxiety and depressive disorders in adolescents with anxiety and depressive disorders. Archives of general psychiatry, 55, 56-64.
  41. Scharff, L. (1997). Recurrent abdominal pain in children: A review of psychological factors and treatment. Clinical Psychology Review, 17, 145–166.
  42. Vaccarino, A. L., Sills,T.L., Evans, K. R., & Kalali,A.H. (2008). Prevalence and association of somatic symptoms in patients with major depressive disorder. Journal of Affective Disorders, 110, 270–276.
  43. Vijay, K.G. Avasthi, A. Grover, S (2014). A study of worry and functional somatic symptoms in generalized anxiety disorder. Asian Journal of Psychiatry, 11, 278-289
  44. Walker, L. S., Garber, J., & Greene, J. (1993). Psychosocial correlates of recurrent childhood pain: A comparison of pediatric patients with recurrent abdominal pain. Journal of Abnormal Child Psychology, 102, 248–258.
  45. Woodward, L. J., & Fergusson, D. M. (2001). Life course outcomes of young people with anxiety disorders in adolescence. Journal of the American Academy of Child & Adolescent Psychiatry, 40, 1086-1093.