Effectiveness of psychosocial intervention for internalizing behavior problems among children of parents with alcohol dependence: Randomized controlled trial

Table 1 Protocol of brief cognitive behavior therapy

Session	Techniques (methods)	Personal projects
I: Initiating therapeutic process	(1) Mini-lecture on effects of alcoholism; (2) Group discussion; (3) In session practice-list the effects of alcoholism on their family; (4) Relaxation exercises; and (5) Psychoeducation	(1) Mood thermometer; and (2) Practice deep breathing exercises
II: Identifying negative thoughts	(1) Mini-lecture on positive and negative thoughts; (2) In session practice list of positive and negative thoughts; and (3) Relaxation exercises	(1) Mood thermometer; (2) List of positive and negative thoughts; (3) Practice deep breathing exercises; and (4) Practice progressive muscle relaxation
III: Identifying thinking errors	(1) Mini-lecture on thinking errors; (2) Group discussion on common thinking errors; (3) In session practice–categorizing negative thoughts into suitable cognitive distortions; and (4) Relaxation exercises	(1) Mood thermometer; (2) Continue to list positive and negative thoughts; (3) Practice deep breathing exercises and progressive muscle relaxation; and (4) Work sheet for recoding thinking errors
IV: Cognitive restructuring	(1) Mini-lecture on distraction techniques; (2) In session practice–converting negative thought into positive thought; and (3) Relaxation exercises	(1) Mood thermometer; (2) Practice some of strategies discussed to improve positive thoughts; (3) Practice deep breathing exercise, progressive muscle relaxation and guided imagery; and (4) Work sheet for recoding thinking errors
V: Untwisting negative thinking	(1) Mini-lecture on 10 ways of untwisting negative thinking; (2) In session practice–challenging cognitive distortions; (3) Group discussion on rational thinking; and (4) Relaxation exercises	(1) Mood thermometer; (2) Practice some of strategies discussed to challenge cognitive distortions; (3) Practice deep breathing exercise, progressive muscle relaxation and guided imagery; and (4) Challenging cognitive distortions
VI: Behavioral activation	(1) Mini-lecture on scheduling pleasurable activities and how to mastery over those activities; (2) In session practice-list of pleasant activities; (3) Relaxation exercises; and (4) Group discussion on healthy lifestyle.	(1) Mood thermometer; (2) Practice deep breathing exercise, progressive muscle relaxation and guided imagery; (3) List of pleasant activities; and (4) Weekly schedule for behavioral activation
VII: Effective coping mechanism	(1) Problem solving game; (2) Mini-lecture on coping mechanism and expression of emotions in healthy way; and (3) Relaxation exercises	(1) Mood thermometer; (2) Practice all relaxation exercises; (3) List of pleasant activities; and (4) Weekly schedule for behavioral activation
VIII: Social skills and assertiveness	(1) Mini-lecture on social skills and assertiveness; (2) Relaxation exercises; and (3) Group sharing on activities learned in each session	Practice techniques learned in all sessions

Table 2 Participants’ baseline characteristics (n = 195) (mean ± SD)

	Experimental group (n = 97)	Control group (n = 98)	P value1
Age in years	14.73 (0.58)	14.63 (0.58)	0.23
Gender
Male (%)	66.0	55.0	0.12
Female (%)	34.0	45.0
Currently studying in
Standard 8 (%)	42.0	46.0	0.60
Standard 9 (%)	58.0	54.0
Type of family
Nuclear (%)	66.0	75.5	0.14
Joint (%)	34.0	24.5
Family monthly income (INR)	9257.73 (3218.69)	9918.37 (3051.69)	0.04a
Duration of paternal alcohol dependence (in years)	7.73 (3.21)	7.31 (2.67)	0.55
Self-esteem	20.05 (4.22)	19.64 (3.73)	0.49
Anxiety	34.65 (7.85)	36.69 (9.36)	0.18
Depression	13.30 (5.56)	12.86 (5.34)	0.54

^aP < 0.05 was significant.

¹χ² for frequencies; t/Mann–Whitney U test for continuous variables.

Table 3 Changes in outcomes from baseline to 6-mo follow-up (n = 195) [median (IQR)/mean ± SD]

Outcomes	Groups	Assessments, baseline	1 mo	3 mo	6 mo	% of improvement	χ2	P valuea	Significant pairs (posthoc)
Self-esteem	Experimental (n = 97)	20 (16.50-23); 20.05 ± 4.22	22 (18.50-24.50); 21.67 ± 4.08	23 (20-26); 22.76 ± 4.28	25 (22-28); 24.98 ± 4.35	25	195.9	0.001	Baseline-1 mo; Baseline-3 mo; Baseline-6 mo; 1-3 mo; 1-6 mo; 3-6 mo
	Control (n = 98)	19 (17-22); 19.64 ± 3.73	20 (17-22); 19.50 ± 3.67	20 (17-22); 19.50 ± 3.67	20 (17-22); 19.45 ± 4.03	5	24.43	0.001	Baseline-6 mo; 1-6 mo; 3-6 mo; 3-1 mo; 3 mo-Baseline; 1 mo-Baseline
Anxiety	Experimental (n = 97)	36 (27-41); 34.65 ± 7.85	29 (24-39); 30.55 ± 7.50	25 (21-32); 26.81 ± 7.68	19 (15-26); 21.82 ± 8.57	47	237.3	0.001	6-3 mo; 6-1 mo; 6 mo-Baseline; 3-1 mo; 3 mo-Baseline; 1 mo-Baseline
	Control (n = 98)	35 (30-42.5); 36.69 ± 9.36	34.50 (29-45); 37.01 ± 10.33	31 (26-46); 35.13 ± 11.23	28.50 (22-45); 33.02 ± 12.43	19	31.9	0.001	6-3 mo; 6-1 mo; 6 mo-Baseline; 3-1 mo; 3 mo-Baseline; Baseline-1 mo
Depression	Experimental (n = 97)	13 (9.50-17); 13.30 ± 5.56	12 (9-15); 12.14 ± 5.03	9 (6-13); 10 ± 5.05	8 (4-10); 7.58 ± 4.71	38	243.5	0.001	6-3 mo; 6-1 mo; 6 mo-Baseline; 3-1 mo; 3 mo-Baseline; 1 mo-Baseline
	Control (n = 98)	12 (9-17); 12.86 ± 5.34	10 (7-16); 11.47 ± 5.44	10.50 (6-6.25); 11.19 ± 6.34	10 (6.75-18); 11.47 ± 6.55	17	48.9	0.001	6 mo-Baseline; 3-1 mo; 3 mo-Baseline; 1 mo-Baseline; 3-6 mo; 1-6 mo

^aP < 0.05 was significant.