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Maar hoe werkt het in het echt? De implementatie van Denken +Doen = Durven, een cognitieve gedragstherapie voor kinderen en jongeren met angststoornissen.
Samenvatting
In 2008 werd het CGT protocol ‘Denken + Doen = Durven (DDD) voor de behandeling van angststoornissen bij kinderen (8 tot 18) jaar uitgegeven. Dit protocol werd eerder in een RCT onderzocht en bleek effectief. Resultaten uit de RCT (efficacy) kunnen niet zondermeer gegeneraliseerd worden naar de klinische praktijk (effectiveness). In deze studie wordt de effectiveness van DDD onderzocht en vergeleken met de efficacy uit de RCT. Deelnemers zijn therapeuten die met DDD werken in de klinische praktijk. Hun cliënten (kinderen en ouders) vulden de SCARED-71 in voor, na en drie maanden na behandeling. Effect sizes (Cohen's d) blijken medium tot groot en het percentage kinderen dat na behandeling geen klinische angstsymptomen meer heeft, neemt toe. DDD is ook in de klinische praktijk effectief. In de RCT waren effect sizes en het percentage kinderen zonder klinische angstsymptomen hoger. In de discussie wordt ingegaan op deze efficacy-effectiveness kloof.
Summary
Doing=Daring' (DDD) for the treatment of childhood anxiety disorders In 2008, the CBT protocol ‘Discussing+Doing=Daring' (DDD) for the treatment of childhood (8-18 years) anxiety disorders, was published. This therapy was highly efficacious in a RCT. Results from this RCT (efficacy) do not necessarily get repeated in real clinical practice (effectiveness). Therefore the effectiveness of this protocol is studied by asking therapists who use DDD in clinical practice to participate in this study. Their patients (children and parents) filled in the SCARED-71 before, after DDD treatment and at three months follow-up. Effect sizes (Cohen's d) were medium tot large and the percentage of children without clinical anxiety symptoms increased after treatment. This study shows that DDD is effective in clinical practice. However, in the RCT effect sizes and percentages of children without clinical anxiety symptoms were higher. This efficacy-effectiveness gap is discussed in the final section.
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