Abstract:
Cognitive Behavioural Therapy (CBT) is a gold standard psychotherapeutic treatment for
anxiety, however, there is limited evidence for its effectiveness in developing countries.
Coping Cat (CC) is an evidence-based manualized CBT intervention for child anxiety. This
study evaluated the effectiveness of Urdu adapted CC program – “Bahadur Billi” in treating
anxiety, fear and behavioral problems in Pakistani school children. “Bahadur Billi”
program was delivered in a randomized control trial in a private school in Islamabad with
22 children aged 8-13 years. Program’s impact was measured using Screen for Children
Anxiety Related Disorders (SCARED), Fear Survey Schedule for Children – Revised
(FSSC-R), and Childhood Anxiety Sensitivity Index (CASI) as primary outcome measures
and Strengths and Difficulties Questionnaire (SDQ) – Parent Version and Kiddie Schedule
for Affective Disorders and Schizophrenia, Present and Lifetime Version (K-SADS-PL) as
secondary outcome measures. ANOVA and ANCOVA revealed significant reductions in
anxiety, fear and behavioral problems in experimental group with small to large effect
sizes. Intent-to-Treat analysis confirmed these results by indicating significant reductions
in the experimental group at follow-up compared to control group. Additionally, “Bahadur
Billi” was deemed feasible and acceptable by therapist and participants. Therapist
demonstrated “considerable” adherence and “good” competence as confirmed by two
independent raters. Conclusively, the “Bahadur Billi” effectively reduced anxiety, fear, and
behavioral problems in Pakistani children emphasizing the potential of culturally adapted
CBT interventions for addressing the issue of untreated childhood anxiety in Pakistan.
