Method
In Study 2, we conducted a pretest-posttest nonequivalent quasi-experimental design. We recruited participants aged between 11 and 12 in an elementary school in Taoyuan, Taiwan. After obtaining the consents of the participants and their parents, we randomly assigned the participants into the experimental group and the control group. The experimental group and the control group received different intervention treatments. The former received a 40-minute Journey of the Brave group counseling session weekly for ten weeks. The latter received a 40-minute career exploration session weekly for ten weeks. Prior and posterior to, and one month after the group counseling treatment, we administered the SCAS-TW, Psychological Well-being Scale, and School Life Adjustment Scale to the participants in the pretest, posttest, and follow-up tests to examine the immediate and follow-up effects. In addition, we also implemented group progress notes, group member feedback questionnaires, and interview with the participants’ homeroom teachers to obtain supplementary data for the study.
Participants
The participants in Study 2 were 16 children aged between 11 and 12. We also invited the participants’ homeroom teacher as participants. The children were randomly assigned to the two groups. The experimental group (N = 8) included three boys and five boys; while the control group (N = 8) include two boys and six girls. After the treatments, we conducted semi-structured interview with five homeroom teachers who consented to participate. Those homeroom teachers understand the participants’ emotional feelings and life adjustment at school.
Instruments
The Journey of the Brave Counseling Program. The study design of Study 2 was based on a CBT based programme “Journey of the Brave” developed by the Research Center for Child Mental Development of Japan Chiba University. After reviewing relevant CBT studies and the development status of elementary school 5th and 6th grade student between the ages of 11 and 12, combing authors’ group counseling experience, we established a Journey of the Brave Counseling Program (JBCP) for children in Taiwan. The JBCP is based on CBT theories, aiming to guide children to understand and confront anxious feelings (show as in Table 3). During the process of learning what anxious feelings and emotions are, children may explore the relation among thoughts, emotions, and behaviors to understand the emotional process and context of being restless and anxious. Through discussions on restless and anxious feelings and situations, children may enhance the awareness of their irrational beliefs and transfer their thoughts and emotions as well as learn to face and adjust their anxious feelings. In addition to some cognitive thinking practice, some practical methods are added into the JBCP, and children practice how to break anxious feelings into specific fragments by systematically checking sensitivity, along with some relaxation technique and interpersonal relation skill developing exercises, to help children gradually face anxious feelings.
SCAS-TW. We used the SCAS-TW developed in Study 1.
Psychological Well-Being Scale (PWS; Lee, 2010). Study 2 used the PWS to examine children’s psychological well-being. The PWS consists of six constructs, namely self-acceptance, autonomy, environment control, self growth, positive interpersonal relationship, and purpose of life. The 36-item PWS is rated on a 4-point Likert’s scale ( strongly disagree = 1, disagree = 2, agree = 3, strongly agree =4), within which are four reverse scoring items. The higher the scores are, the higher degree of psychological well-being. The internal consistency reliability of the PWS is .03, and the Cronbach’s alpha coefficient is .93. Factor analysis reported that the factor loadings of each item is above .70, and the six factors could explain 77.81% of total sum of square of the 36-item scale, indicating good reliability and validity.
School Life Adjustment Scale (SLAS; Wang et al. 2017). The SLAS is used to assess children’s adjustment on all aspects situations at school. The SLAS was developed in 2012 by the authors, consists of 3 subscales, the Adjustment on the Teacher-Student Relationship (TSR), Adjustment on the Self-Peer Relationship (SPR), and Adjustment on the Academic Challenge (AC). This is a 12-item scale, rated on a 4-point Likert scale (strongly disagree = 1, disagree = 2, agree = 3, and strongly agree = 4). The AC subscale is reverse scored. The higher the scores are for the SLAS, the better the children’s school life adjustment is. Confirmatory factor analysis reported that the scale had a stable two-factor structure (Bi-Factor Model; RMSEA =.06, SRMR =.05, CFI =.97). There was a positive moderate correlation between the three subscales of the SLAS and confidence and the ability to solve problems, and a negative correlation with internal and external behaviors, indicating that the scale had good criterion-related validty.
Other instruments applied in Study 2 were group member feedback questionnaires, interview portfolios, and group progress notes. Group member feedback questionnaires were developed by one of the authors, aiming to understand participants’ experience and feedback after they receive group counseling session treatments. The questionnaire includes three sections. The first section asked about participants’ basic information. The second section asked about participants’ feedback about the group activities they have taken part in, rated on a 5-point Likert scale. The third section consists of open questions asking about participants’ reflection on participating in group counseling sessions. Another instrument we used in Study 2 were interview portfolios for semi-structured interviews with the experimental group participants’ homeroom teachers. In the interviews, the homeroom teachers shared what they observed from the participants about their emotions, interpersonal relation, and changes after they received the JBC treatment. The group progress notes were taken after every counseling treatment, in which counseling leaders made records of every counseling session process and the reaction of group participants to evaluate the efficiency of the group counseling and participants’ behaviors and statuses. The counseling leader is a researcher, with a background in psychological counseling and experience in leading group counseling, and is currently working as a tutor in a primary school.
Data Analysis
In Study 2, we analyzed the data collected from the scores of the experimental and control groups on the pretests, posttests, and follow-up tests for the SCAS-TW, PWS, and SLA. The quantitative data was analyzed via analysis of variance to test the hypotheses. As for the qualitative data, we conducted content analysis to transcribe, code, and analyze the data collected from group feedback questionnaires, semi-structured interviews, and group process notes. The data would be used as supplementary data to evaluate the effectiveness of the group counseling.
Results
The Immediate Effects of the JBCP on Anxiety, Well-Being, and Life Adjustment in Taiwanese Children
Anxiety. We conducted the test of homogeneity of within-group regression coefficient to eliminate the existence difference between the experimental and control groups. This was to reduce the impact of the differences on the pretest, and then we carried out analysis of covariance to compare the differences between the experimental and control groups in the pretests and posttests for and of the SCAS and subscales and reduced the impact of the pretests. The test score of homogeneity of within-group regression coefficient of the experimental and control groups on the posttest for the SCAS scale and subscales, (F[1,12]=3.19, .36, .02, .14, .00, .12, .00, p>.05), did not reach a significant level, indicating that the slopes in the posttest of the experimental and control groups for the SCAS scale and subscales were the same. The result was consistent with the assumption of homogeneity of regression coefficient, and then we preceded to conduct analysis of covariance. The analysis of covariance reported that the scores of the experimental and control groups in the posttest on the SCAS scale (F[1,13]=1.38, p=.26, p>.05) did not reach a significant level. However, the scores of the experimental group on the posttest for the Separation Anxiety subscale of the SCAS, (F[1,13]=7.06, p=.02, p<.05), were significantly lower than the control group. This indicated that after the group counseling treatment, the anxiety level of the experimental group participants was significantly than the control group.
After eliminating the pretest effect, the average scores of the experimental group on the posttest after adjusted for the SCAS scale and subscales were lower than those of the control group( As shown in Table 4). This indicated that even though the posttest scores of the experimental and control groups was not significant, with the experimental treatment, the overall anxiety level of the experimental group were lower than that of the control group, which confirmed that the JBCP had immediate effect on anxiety in children.
Well-Being. The test of homogeneity of within-group regression coefficient reported that the scores of the experimental and control groups in the posttest on the PWBS scale and subscales, (F[1,12]=.11, .97, .87, .40, .57, .35, .07, p>.05), did not reach a significant level, indicating that the slopes in the posttest of the experimental and control groups for the PWBS scale and subscales were the same. The result was consistent with the assumption of homogeneity of regression coefficient, and then we preceded to conduct analysis of covariance to compare the difference between the experimental and control groups in the pretest and posttest on the PWBS scale and subscales. However, the analysis of covariance showed that scores of the two groups for the PWBS scale and subscales did not reach a significant level, which indicates that there was no significant difference between the two groups in the posttest scores for the PWBS scale and subscales.
Life Adjustment. The test of homogeneity of within-group regression coefficient reported that the scores of the experimental and control groups in the posttest on the SLAS scale and subscales, (F[1,12]=1.49, .026, 1.30, 1.92, 3.25, p>.05), did not reach a significant level, indicating that the slopes in the posttest of the experimental and control groups for the SLAS scale and subscales were the same. The result was consistent with the assumption of homogeneity of regression coefficient, and then we preceded to conduct analysis of covariance to compare the difference between the experimental and control groups in the pretest and posttest on the SLAS scale and subscales. However, the analysis of covariance showed that posttest scores of the two groups for the SLAS scale and subscales did not reach a significant level, which indicates that there was no significant difference between the two groups in the posttest scores for the SLAS scale and subscales.
Analyses of the Follow-up Effects of the JBCP on Anxiety, Well-Being, and Life Adjustment in Taiwanese Children
Anxiety. The test of homogeneity of within-group regression coefficient reported that the scores of the experimental and control groups in the follow-up test on the SCAS scale and subscales, (F[1,12]=4.12, .002, 1.29, .04, .09, 1.16, .45, p>.05), did not reach a significant level. The result was consistent with the assumption of homogeneity of regression coefficient, and then we preceded to conduct analysis of covariance to compare the difference between the experimental and control groups in the pretest and follow-up test on the SCAS scale and subscales. However, the analysis of covariance showed that posttest scores of the two groups for the SCAS scale and subscales did not reach a significant level, which indicates that there was no significant difference between the two groups in the follow-up scores for the SLAS scale and subscales. As shown in Table 5, after eliminating the pretest effect, with the experimental treatment, the average scores of the experimental group on the follow-up test after adjusted for the SCAS scale and subscale were lower than those of the control group. However, one month after the experimental treatment, the overall anxiety level and other anxiety aspects in the experimental group participants were lower than the control group. This confirmed that the JBCP had a significant follow-up effect on anxiety in children.
Well-Being. The test of homogeneity of within-group regression coefficient reported that the scores of the experimental and control groups in the follow-up test on the PWBS scale and subscales, (F[1,12]=.006, .56, 1.54, .40, .20, .26, .18, p>.05), did not reach a significant level. The result was consistent with the assumption of homogeneity of regression coefficient, and then we preceded to conduct analysis of covariance to compare the difference between the experimental and control groups in the follow-up test on the PWBS scale. The analysis of covariance showed that follow-up scores of the two groups on the PWBS had no significant difference, but the control group significantly scored higher than the experimental group on the follow-test for the Purpose of Life subscale, (F[1,13]=8,96, p=.01, p<.05). The results showed that one month after the experimental treatment, the experimental group did not score better than the control group, while the control group scored better for the Purpose of Life than the experimental group.
Life Adjustment. The test of homogeneity of within-group regression coefficient reported that the scores of the experimental and control groups in the follow-up test on the SLAS scale and subscales, (F[1,12]=.79, 2.31, .22, 1.63, p>.05), did not reach a significant level. The result was consistent with the assumption of homogeneity of regression coefficient, and then we preceded to conduct analysis of covariance to compare the difference between the experimental and control groups in the pretest and follow-up test on the SLAS scale and subscales. The analysis of covariance showed that follow-up scores of the two groups on the SLAS and the subscales had no significant differences. The results showed that one month after the group counseling, the experimental group did not score better for school life adjustment.
Qualitative Data Analysis
Group Member Feedback Questionnaires. In the qualitative assessment of the group member feedback questionnaires, the average rating of the experimental group participants was above 3. Among them, 74.4% of the feedback were rated 4 (correct) and 5 (very correct). This demonstrates that the experimental group participants’ attitudes were very positive toward the JBCP sessions. The participants were very impressive with the program activities, such as Units “Knowing the Anxious Feelings,” “the Way of Relaxation,” “the Naughty Elf,” and “the Way the Brave talks.” Through learning, most participants felt that they knew themselves more during the JBCP sessions. They understood what initiated their cognitive thinking, emotions, and behaviors. They began to be more patient with some situations and knew how to cope with anxious feelings. Besides, they learnt how to express themselves. Overall, the experimental group participants found that the JBCP activities were helpful to them. As for the experience and feelings, the participants enjoyed the part where they played and interacted with other group members. They were impressed with the interactions with others. Therefore, most participants felt that they could sincerely express themselves. They trusted and cared about one another and felt freely and pleasantly to take part in the activities a group leader guided in the group. All above showed that the JBCP was beneficial to release anxiety in children and their self-acceptance, autonomy, and self-per relationship.
Semi-Structured Interviews with Homeroom Teacher. After the counseling treatment, we carried out content analysis to analyze semi-structured interviews. Five questions were addressed with analyses as follow:
(1) “Have the participants shared their experience and feeling of taking part in the group counseling sessions?” As for the participants experience sharing part: The participants were impressed with the interaction, conflicts, or some incidents happened during the Naughty Elf session. This indicated that the experimental group participants learned and gained something during the group activities. However, the participants’ emotions were also influenced by the group activities, conflicts, or incidents. Their opinions about the JBCP were that they enjoyed the group activities. However, they felt bothered for the group session tardiness of some participants or when their classwork or homework was not completed yet. This showed that the experimental group participants were motivated to take part in the JBCP activities and gained positive experience and feelings during the sessions. However, their performance may be interrupted by other participants or the need to adjust themselves to school or class regulations. (2) “Whether can the children clearly describe an incident’s cause and effect, their own thoughts, emotions, and reaction?” Apart from few participants with special needs and had difficulty expressing themselves or clearly describing an incident, most participants made progress in describing the cause and effect of an incident, expressing their own thoughts, emotions, or reaction. This indicates that the JBCP help to improve the cognition or expression ability of the experimental group members. After the participants reflect on their cognition, they became more aware of their own status within an incident and more comprehensively realizing themselves than before. (3) “After taking part in the JBCP sessions, do the children make any change in emotional expression?” Almost all the experimental group participants made some progress in their emotional expression, which shows that the JBCP successfully helped participants recognize, accept, and deal with their own negative emotions, such as anger, anxiety, etc. This also confirms that the JBCP has effects on anxiety and self-acceptance. Once the participants began to adjust and cope with their behavior to avoid conflicts with other people, they proved that the JBCP also has effect in autonomy and self-peer relationship. (4) “After taking part in the JBCP sessions, do the children make progress in study, interpersonal relationship, and school life? If they do, in what part have you ever noticed? What are the reasons you think may make them make progress? If they don’t, do you think what the reasons are?” As for interpersonal relation, most experimental group participants make different degree of progress, confirming the effect of JBCP on improving interpersonal relationship. As for study and life adjustment, even though the homeroom teachers did not see any change in academic performance or other life adjustment, still some participants improved their learning motivation. This shows that the JBCP might have effects on adjustment on academic performance, but there was no significant counseling effect. The homeroom teachers thought that three reasons motivated the participants. One was the participants’ caring and cooperation, another was the guidance and instructions given in the experimental group sessions, and the other was the time spent on practice and adjustment. The participants made progress under the cooperation among varieties of systems. They also implemented what they learned in the JBCP sessions into daily life and made some adjustments. Besides, the homeroom teachers stated two reasons why the experimental group participants failed to make progress in some parts. One was due to that some participants’ absence from and tardiness to school influenced their daily school assignment, they lacked the opportunities to learn and interact with peers. The other was due to that the participants were not ready and determined to make changes and take challenges. From this we can learn that the absence or tardiness influence the participants’ daily work, which may also influence the attendance to the JBCP. Besides, their mentally preparation also influenced their academic performance and interpersonal relationship within a group. (5) “Overall, what is the greatest benefit that the JBCP brings to the children?” The homeroom teachers referred to three beneficial parts. First, that the participants learnt better ways to adjust and express their emotions. Second, the participants learned to interaction with others and gained the opportunities to express their thoughts and feelings. Third, they were allowed to relax and take break and gained interpersonal and emotional support. This shows that the JBCP not only helps the participants learn how to express their emotions and interact with peers but also offer a secure and peaceful space for them to seek mental support from.
Group Process Note. We made a comprehensive analysis into the group progress notes taken during the 10 JBCP sessions:
Group Participation. Some experimental group participants had difficulty attending all group sessions, which also made influence on other participants in their experience and learning. Besides, the group session arrangement was confined with school events. The sessions could not be scheduled in a continuous week for 10 weeks. Due to the long interval time span, it took time for the participants to warm up and get associated with previous JBCP sessions. The irregular JBCP session routine also influenced the session experience and effects of the JBCP.
Group Participants’ Performance. After each group activity, the counseling leader would rate the participants’ performance in the group (score 1 to 5 points). The participants’ performance including active participation, compliance with norms, careful sharing, active listening, and altruistic behavior.The experimental group participants’ performance in the group was above average. Most experimental group participants actively took part in group activities. They got high scores for active participation, following the rules, and being keen to share. The experimental group participants had stronger motivation. They followed directions and were willing to take part in group activities as well as actively express their thoughts. This demonstrates that the experimental group participants were carefree while being in the group and the atmosphere was active and cheerful. The experimental group participants scored lower for actively listening and altruistic behavior, which indicates that the participants were not good at waiting and listening to others. Some of them were eager to share their own thoughts and ignored other participants or ongoing activities, and this disturbance interfered with orders within the group and group progress. The low score for altruistic behavior shows that even though the experimental group participants positively interacted with others in the group and made positive feedback to others. They seldom reached out their hands to help other people, and some participants argued or had quarrels with other participants. These conducts greatly influenced the atmosphere in the group and group activities progress.
The Reflection of Group Leaders. The JBCP guided the experimental group members to view events or emotions from a cognitive perspective and learn to understand the origin of the emotions to bring themselves new awareness and adjustment. However, the JBCP sessions also required the participants’ cognitive ability. Two units in the JBCP sessions, “Applied Skill-A Ladder for the Brave” and “an Ultimate Weapon of the Brave-How the Brave Thinks” needed one’s better cognitive abilities to understand. Therefore, it took more time to guide the participants to practice for a better perception and awareness. These two sessions demanded more counselors to guide the participants, but in the current study, there was only one group leader. Due to the limited attention, not all participants were always attended, lowering the benefits of the program to all participants.