Programs that Work
Healthy and Safe Children
Children not experiencing anxiety or mood disorders, such as depression
Age of Child
Early Childhood (0-8)
Middle Childhood (9-12)
Type of Setting
Community-Based Service Provider
Health Care Provider
Type of Service
Health Care Services
Type of Outcome Addressed
Evidence Level (What does this mean?)
The Coping Cat program is a cognitive-behavioral therapy intervention that helps children recognize and analyze anxious feelings and develop strategies to cope with anxiety-provoking situations. The program focuses on four related components: (1) recognizing anxious feelings and physical reactions to anxiety; (2) clarifying feelings in anxiety-provoking situations; (3) developing a coping plan (for example, modifying anxious self-talk into coping self-talk, or determining what coping actions might be effective); and (4) evaluating performance and administering self-reinforcement. By incorporating adaptive skills to prevent or reduce feelings of anxiety, the Coping Cat therapist uses a workbook to guide the child through consideration of previous behavior in situations in which the child felt anxious, as well as the development of expectations for future behavior in anxious situations. The Coping Cat workbook is used for children aged 8 to 13 years and the C.A.T. Project workbook is used for children aged 14 to 17 years. The C.A.T. Project differs from Coping Cat only in the use of developmentally appropriate pictures and examples for older ages.
Children and youth aged 8-17 years
The first evaluation of Coping Cat was published in 1994 by Philip C. Kendall, in a study of 47 children aged 9 to 13 years. The sample consisted of 27 children receiving the intervention and 20 wait-list control participants. The intervention participants were mostly Caucasian (78 percent), and 22 percent were African American. Of the 47 study participants, clinical interviewers at baseline diagnosed 30 participants with overanxious disorder (64 percent), 8 were diagnosed with separation anxiety disorder (17 percent), and 9 were diagnosed with avoidant disorder (19 percent; characterized by an excessive avoidance of contact with unfamiliar people). Children were excluded from the study if they had an IQ below 80, a disabling physical condition, displayed psychotic symptoms, or were currently using antianxiety medications. After the intake interview, 60 eligible subjects were randomly assigned to either the 16-week Coping Cat intervention or the wait-list control group. Treated subjects were randomly assigned to therapists. After an 8-week waiting period (i.e., after the first half of the intervention), the wait-list control subjects were randomly assigned to therapists and participated in the intervention. Outcomes were measured after 8 weeks for the control group (i.e., before they underwent the treatment), and after 16 weeks for the intervention group. Outcome measures included child self-reports of anxiety, fear, depression, coping, and negative thoughts; parent reports of child behavior and child anxiety; teacher reports of child behavior; and direct behavioral observations of child anxiety by researchers. Pretreatment differences across groups were not significant. Of the 60 initial subjects, 13 did not complete the study. Attrition analyses revealed no significant differences between study completers and dropouts.
In a second study of Coping Cat, Kendall et al. (1997) assessed 94 children aged 9 to 13 years, including 60 intervention and 34 wait-list control participants. The initial pool of 118 participants with primary anxiety disorders had all been referred from community sources, and 24 children subsequently dropped out of the study. Of the 94 children included in the final analysis, 55 were diagnosed at intake with overanxious disorder, 22 with separation anxiety disorder, and 17 with avoidant disorder. Children were excluded if they displayed psychotic symptoms, if their primary diagnosis was simple phobia, or if they were currently using antianxiety medications. After intake, participants who met the eligibility criteria were randomly assigned to either the 16-week Coping Cat program (60 children) or the 8-week waiting list control condition (34 children). Of the study participants, 58 percent of the intervention group was male compared with 68 percent of the control group. The majority of the sample was Caucasian (87 percent of the intervention group versus 82 percent of the control group). Groups were compared for pretreatment differences in terms of age, gender, race, and all dependant variables, and no significant differences were found between groups. Outcomes were assessed via child self-reports of anxiety, fear, depression, coping, and negative thoughts; parent reports of child behavior, anxiety, and coping skills; teacher reports of classroom behavior; and researcher observations of children’s anxious behavior. Outcomes for the treatment group were assessed posttreatment (16 weeks), while outcomes for the wait-list control group were assessed after the waiting-list period (8 weeks).
Flannery-Schroeder and Kendall (2000) assessed the effects of Coping Cat in a sample of 37 children aged 8-14 years. Subjects were referred by a clinic and had all been diagnosed with an anxiety disorder, including 21 children with generalized anxiety disorder, 11 with separation anxious disorder, and 5 with social phobia. Exclusion criteria for participation included having a disabling physical condition, psychotic symptoms, or currently using antianxiety or antidepressant medication. The initial study sample included 45 children, and 8 children subsequently dropped out of the study. Subjects were randomly assigned to (a) individual cognitive-behavioral treatment (ICBT, 13 students), (b) group cognitive-behavioral treatment (GCBT, 12 students in four single-gender groups), or (c) wait-list control (12 students). After nine weeks, the 12 control subjects began the Coping Cat program. Analyses of pretreatment group differences in terms of age, gender, race, family income, and parent levels of education revealed no significant differences among groups. In a comparison of pretreatment dependent variable scores across groups, some means on child-reported measures were found to differ significantly. Scores on measures of state anxiety (i.e., situational anxiety) and trait anxiety (i.e., enduring tendency to experience anxiety) scales of the State-Trait Anxiety Inventory were significantly lower in the GCBT group compared to the ICBT and control groups. Additionally, mean scores in the GCBT group were significantly lower than scores in the control group on the measures of loneliness and social anxiety. Treatment outcomes were assessed via clinician interviews; child self-reports of anxiety, depression, coping skills, self-perception, loneliness, friendship, and recall of treatment curriculum; parent reports of child behavior, anxiety, coping skills, social activities, and peer relationships; and teacher reports of classroom behavior.
Key Evaluation Findings
The initial study by Kendall (1994) found:
- Child self-reports: All measures reported by children revealed significantly more positive outcomes for the intervention group participants than for the control group participants. Specifically, the intervention group had better outcome scores than the control group on
- anxiety measures
- fear scores
- perceived ability to cope with most-dreaded situations
- frequency of negative thoughts during the past week
- Parent reports: Similar to the child self-report measures, all of the parent assessments of child behavior and anxiety showed significant, positive effects for the intervention. Specifically:
- Intervention group parents rated their children more positively on all four behavior scales, including internalizing behavior, social behavior, health, and externalizing behavior.
- Parent reports of their child’s state-trait anxiety also showed a significant effect favoring the intervention group.
- Teacher reports: No significant differences were found for either the internalizing or externalizing behavior scores.
- Behavioral observations: No significant differences were found between groups for the behavioral observation measures when looked at individually. However, when scales were merged into a single score, a significant effect was found that favored the intervention group.
- Clinician interviews: Using results from the parent interview used to diagnose the child’s primary anxiety disorder at intake, 71 percent of the treated children at the end of treatment (16 weeks) no longer met criteria for their initial diagnosis as a primary clinical diagnosis. Fifty-three percent no longer met criteria for a primary anxiety disorder at all. Of the control participants, only 6 percent did not qualify for their primary anxiety disorder diagnosis after the waiting-list period (8 weeks).
- Child self-reports: All of the child report measures found either significant or marginally significant positive effects favoring the intervention group. These included
- significant effects for reductions in anxiety
- significant effects for reduction of fear
- significant improvements in ability to cope with dreaded situations
- a significant reduction in the frequency of negative thoughts during the past week
- a marginally significant effect for reduced depression.
- Parent reports:
- Significant outcomes favoring the Coping Cat participants were found for both mothers' and fathers' internalizing behavior scores.
- Significantly more positive scores for the intervention group children were also noted in mothers' anxious-depressed scores and anxiety scores; however, no significant effects were found for fathers' reports on these scores.
- Parent reports of children’s state-trait anxiety were significantly more positive for intervention group children than for control group children.
- Both mothers' and fathers' reports of coping skills revealed significantly superior coping outcomes for intervention group children.
- Teacher reports: No significant group differences were found for the teacher’s reports of children’s internalizing or externalizing classroom behavior problems.
- Behavioral observations: Significantly better outcomes were found for the intervention group for two anxious behaviors—trembling voice and fingers in mouth—while differences between groups were not found for absence of eye contact.
- Clinician Interviews: Using parent ratings, at posttest significantly more treated children than control children no longer met diagnostic criteria for their primary anxiety disorder (73 percent for the ICBT group, 50 percent for the GCBT group, and 8 percent for the control group). No significant differences were found between the ICBT and GCBT groups.
- Child self-reports:
- No significant differences were found among groups for anxiety as measured by the Revised Children’s Manifest Anxiety Scale.
- Significant group differences were found on the state anxiety and trait anxiety scales of the State-Trait Anxiety Inventory.
- For trait anxiety, results indicated that both the ICBT and the GCBT groups demonstrated a significant reduction in scores from pretest to posttest, while the control group did not show a significant reduction in scores.
- For state anxiety, only the ICBT group showed significant improvement from pretest to posttest.
- An analysis of the combined child reports of social functioning yielded no significant differences among groups in change scores from pretest to posttest.
- A significant effect was found for coping skills. Both treated groups improved their self-reported coping from pretest to posttest, while the control group did not.
- No significant differences were found among groups for depression scores.
- For recall of content, significant differences were found between the treatment groups, with ICBT participants recalling significantly more of the Coping Cat curriculum than GCBT participants.
- Parent and teacher reports:
- Fathers' reports of child anxiety showed significant differences among groups, with reductions in anxiety found for both the ICBT and GCBT groups, but not for the control group. Differences in mothers' reports of child anxiety were not significant.
- In regard to parent scores for the child’s ability to deal with anxiety-provoking situations, significant differences emerged among groups. Mothers' reports showed that the ICBT and GCBT groups showed increases in coping from pretest to posttest, while no change was shown for the control group. Similar results were found for fathers' reports.
- An analysis of a combination of the measures assessing social functioning showed no significant differences among groups.
- Results showed significant group differences for fathers' reports of internalized distress as rated on the Child Behavior Checklist (CBCL) internalizing scale, with both the ICBT and GCBT groups showing a decrease in distress scores from pretest to posttest and no significant change for the control group.
- No significant differences were found in either mothers' or teachers' reports of internalizing scores on the CBCL.
Community-based child and youth organizations, school psychologists, private therapists, mental health centers and clinics.
Previous funding for the implementation and evaluation of Coping Cat has been provided by the National Institute of Mental Health. Sources for current funding of program implementation may include mental health agencies, private service providers, and school districts.
The Coping Cat program provides children and youth with information about anxiety and ways of coping with situations that previously caused anxiety and fear. Behavioral training strategies such as cognitive restructuring, modeling, guided imagery, simulation, real-life exposure, role-playing, relaxation training, and contingent reinforcement are used. Children are taught how to verbally reinforce their own successful coping and are encouraged to practice using the coping skills when anxiety-provoking situations arise.
The first eight sessions of the Coping Cat program involve an introduction of the basic concepts, followed by practice and reinforcement of the skill.
- In Session 1, the therapist builds a rapport with the child and collects specific information about the kinds of situations and experiences during which the child feels anxious, and the ways in which the child responds to that anxiety.
- Session 2 involves teaching the child to identify different types of feelings.
- In Session 3, children construct a hierarchy of anxiety-provoking situations so that they can distinguish anxious reactions from other types of reactions and can identify their own particular somatic responses.
- After Session 3, a meeting is held with the child’s parents to review the treatment goals, share impressions and ideas, receive parental input on particular problem areas for each child, and encourage parental involvement in the treatment.
- In Session 4, children are taught how to relax outside of the sessions by listening to a cassette tape containing personalized relaxation content.
- Session 5 consists of teaching the child to recognize and assess self-talk during anxious situations and to reduce self-talk that is anxiety provoking.
- Session 6 emphasizes coping strategies such as coping self-talk and verbal self-direction, as well as developing appropriate actions to help cope with anxious situations.
- In Session 7, children learn how to self-evaluate and self-reward.
- Session 8 comprises reviewing concepts and skills covered in the previous sessions.
- In Session 9, the child practices the newly learned skills in nonstressful, low-anxiety situations that begin with imaginary experiences and progress to real-life exposure. Practice includes therapist modeling and role-plays.
- In Sessions 10 to 13, the child is exposed to imaginary and real situations that cause increasing levels of anxiety.
- In Sessions 14 and 15, children practice in high-stress, high-anxiety situations.
- The final session is used to discuss the therapy experience, to review the skills, and to encourage the child to think about how to apply the skills in everyday life.
Coping Cat therapists are trained providers with advanced degrees in psychology.
Issues to Consider
This program received a "promising" rating. All three studies of Coping Cat found that participants experienced a wide range of significant, positive outcomes when compared with control group participants. Findings for child self-report measures were the most robust across the studies, while parent reports and behavioral observations were somewhat mixed. No significant program impacts were found in any of the studies for teacher reports of classroom functioning.
The major limitation in all three of the studies was the use of a short-term wait-list control group. While the authors cite ethical problems with forcing a 16-week or more delay in providing treatment to control group participants, the strength of the study findings is limited by the short-term nature of the follow-up measurement of outcomes. In addition, the studies are limited by the fact that outcomes were assessed at different times for the intervention and control groups. For example, for Kendall (1994) and Kendall et al. (1997), results for the intervention group were assessed after completion of the 16-week program, while results for the control group were assessed after 8 weeks, just before wait-list control group participants began the treatment. Similar timing was used in the study by Flannery-Schroeder and Kendall (2000). The timing of the outcomes assessment calls into question whether the significant differences between groups would have held beyond the initial 8-week interval, as well as whether other factors in the children’s environments at the treatment midpoint may have affected the observed outcomes.
The study by Flannery-Schroeder and Kendall (2000) comparing individual (ICBT) and group cognitive-behavioral therapy (GCBT) with a waiting-list control group found few differences between the two treatment groups. The study was limited by numerous pretest differences between groups; however, the results do not suggest the superiority of either method of program delivery. Of interest were the results on the recall of content measure, in which it was determined that GCBT participants recalled significantly less information relating to the treatment protocol, which may suggest that they are less likely to use program skills in the future.
An evaluation of a Dutch adaptation of the Coping Cat program suggests that the addition of a cognitive parent-training group to the program does not result in additional benefits. Nauta et al. (2003) studied the effects of Coping Cat in a sample of 79 children from the Netherlands. Participants were randomly assigned to one of the three treatment conditions: cognitive-behavioral training (CBT) only, CBT plus seven sessions of parent training, or a control group. Results indicated significant differences between both treatment groups and the control group, but no differences between the treatment groups themselves. Despite the fact that these findings suggest that additional parent training may not be warranted, it should be noted that the program was a shortened version of Coping Cat, and the study was conducted outside of the United States, thus possibly introducing cultural differences that are not necessarily generally applicable. Furthermore, it is possible that the specific type of parent training is important and that a modified curriculum may have imparted more success.
Canadian and Australian adaptations of the Coping Cat program have been developed, which use variations of the Coping Cat curriculum. In Canada the program is called Coping Bear, while in Australia it has been dubbed Coping Koala or, more recently, FRIENDS.
Finally, it should be noted that the program developer served as an evaluator on all three of the Coping Cat evaluations reviewed.
Los Angeles, CA
New York, NY
For information about research on the Coping Cat program, contact:
Philip C. Kendall, Ph.D., ABPP
Department of Psychology
Director, Child and Adolescent Anxiety Disorders Clinic
Weiss Hall 478, Temple University
1701 North 13th Street
Philadelphia, PA 19122-6085
phone: (215) 204-1558
clinic phone: (215) 204-7165
fax: (215) 204-5539
Flannery-Schroeder, Ellen C., and Philip C. Kendall, Cognitive-Behavioral Therapy for Anxious Children: Therapist Manual for Group Treatment, 1996, Workbook Publishing: Ardmore, PA.
Kendall, Philip C., and Kristina A. Hedtke, Cognitive-Behavioral Therapy for Anxious Children: Therapist Manual, 3rd Edition (Child/Individual treatment manual), 2006, Workbook Publishing: Ardmore, PA.
Kendall, Philip C., and Kristina A. Hedtke, Coping Cat Workbook, 2nd Edition, 2006, Workbook Publishing: Ardmore, PA.
Kendall, Philip C., Muniya Choudhury, Jennifer Hudson, and Alicia Webb, "The C.A.T. Project" Manual for the Cognitive Behavioral Treatment of Anxious Adolescents, 2002, Workbook Publishing: Ardmore, PA.
Kendall, Philip C., Muniya Choudhury, Jennifer Hudson, and Alicia Webb, "The C.A.T. Project" Workbook for the Cognitive Behavioral Treatment of Anxious Adolescents, 2002, Workbook Publishing: Ardmore, PA.
To order books or DVDs/videos on Coping Cat, visit:
phone: (610) 896-9797
fax: (610) 896-1955
Training for Coping Cat therapists is often provided in workshops or at local and national professional meetings. To arrange for therapist training, contact Dr. Philip Kendall (as listed above).
Flannery-Schroeder, Ellen C., and Philip C. Kendall, "Group and Individual Cognitive-Behavioral Treatments for Youth with Anxiety Disorders: A Randomized Clinical Trial,"
Cognitive Therapy and Research,
Vol. 24, No. 3, 2000, pp. 251-278.
Kendall, Philip C., "Treating Anxiety Disorders in Children: Results of a Randomized Clinical Trial," Journal of Consulting and Clinical Psychology, Vol. 62, No. 1, 1994, pp. 100-110.
Kendall, Philip C., Ellen Flannery-Schroeder, Susan M. Panichelli-Mindel, Michael Southam-Gerow, Aude Henin, and Melissa Warman, "Therapy for Youths with Anxiety Disorders: A Second Randomized Clinical Trial," Journal of Consulting and Clinical Psychology, Vol. 65, No. 3, 1997, pp. 366-380.
Nauta, Maaike H., Agnes Scholing, Paul M. G. Emmelkamp, and Ruud B. Minderaa, "Cognitive-Behavioral Therapy for Children with Anxiety Disorders in a Clinical Setting: No Additional Effect of a Cognitive Parent Training," Journal of the American Academy of Child and Adolescent Psychiatry, Vol. 42, No. 11, 2003, pp. 1270-1278.