Implementation of Urdu Adapted Version of Coping Cat – “بہادر بلی” in School Setting

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.