Treatment of child anxiety disorders via guided parent-delivered cognitive–behavioural therapy: Randomised controlled trial

BackgroundPromising evidence has emerged of clinical gains using guided self-help cognitive–behavioural therapy (CBT) for child anxiety and by involving parents in treatment; however, the efficacy of guided parent-delivered CBT has not been systematically evaluated in UK primary and secondary settings.AimsTo evaluate the efficacy of low-intensity guided parent-delivered CBT treatments for children with anxiety disorders.MethodA total of 194 children presenting with a current anxiety disorder, whose primary carer did not meet criteria for a current anxiety disorder, were randomly allocated to full guided parent-delivered CBT (four face-to-face and four telephone sessions) or brief guided parent-delivered CBT (two face-to-face and two telephone sessions), or a wait-list control group (trial registration: ISRCTN92977593). Presence and severity of child primary anxiety disorder (Anxiety Disorders Interview Schedule for DSM-IV, child/parent versions), improvement in child presentation of anxiety (Clinical Global Impression –Improvement scale), and change in child anxiety symptoms (Spence Children's Anxiety Scale, child/parent version and Child Anxiety Impact scale, parent version) were assessed at post-treatment and for those in the two active treatment groups, 6 months post-treatment.ResultsFull guided parent-delivered CBT produced superior diagnostic outcomes compared with wait-list at post-treatment, whereas brief guided parent-delivered CBT did not: at post-treatment, 25 (50%) of those in the full guided CBT group had recovered from their primary diagnosis, compared with 16 (25%) of those on the wait-list (relative risk (RR) 1.85, 95% CI 1.14–2.99); and in the brief guided CBT group, 18 participants (39%) had recovered from their primary diagnosis post-treatment (RR = 1.56, 95% CI 0.89–2.74). Level of therapist training and experience was unrelated to child outcome.ConclusionsFull guided parent-delivered CBT is an effective and inexpensive first-line treatment for child anxiety.

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Face-to-face versus Video Teleconference Group Cognitive Behavioural Therapy for Anxiety and Related Disorders: A Preliminary Comparison: Thérapie cognitivo-comportementale de groupe en personne contre par vidéo téléconférence pour l’anxiété et les troubles connexes: une comparaison préliminaire

The Canadian Journal of Psychiatry ◽

10.1177/07067437211027319 ◽

2021 ◽

pp. 070674372110273

Author(s):

Irena Milosevic ◽

Duncan H. Cameron ◽

Melissa Milanovic ◽

Randi E. McCabe ◽

Karen Rowa

Keyword(s):

Anxiety Disorder ◽

Anxiety Disorders ◽

Cognitive Behavioural Therapy ◽

Behavioural Therapy ◽

Symptom Improvement ◽

Face To Face ◽

Compulsive Disorder ◽

Cognitive Behavioural ◽

Group Cbt ◽

Delivery Formats

Objective: Telehealth is being increasingly incorporated into the delivery of mental health care and has received widespread attention during the COVID-19 pandemic for its ability to facilitate care during physical distancing restrictions. Videoconferencing is a common telehealth modality for delivering psychotherapy and has demonstrated similar outcomes to those of face-to-face therapy. Cognitive behavioural therapy (CBT) is the most common psychotherapy evaluated across various telehealth modalities; however, studies on CBT delivered via videoconference, particularly in a group therapy format, are lacking. Further, little research exists on videoconference group CBT for anxiety disorders. Accordingly, the present study compared the outcomes of group CBT for anxiety and related disorders delivered via videoconference versus face-to-face. Method: Using a non-randomized design, data on attendance, dropout, clinical outcomes, and functional impairment were collected from 413 adult outpatients of a tertiary care anxiety disorders clinic who attended a CBT group for panic disorder/agoraphobia, social anxiety disorder, generalized anxiety disorder (GAD), or obsessive-compulsive disorder delivered either face-to-face (pre-COVID-19 pandemic) or via videoconference (since the onset of COVID-19 pandemic). Outcomes were assessed using well-validated self-report measures. Data were collected pre-treatment, across 12 weekly sessions, and post-treatment. Intent-to-treat analyses were applied to symptom outcome measures. Results: Face-to-face CBT conferred only a slight benefit over videoconference CBT for symptom outcomes across all groups, but when assessed individually, only the GAD group showed greater symptom improvement in the face-to-face format. Effect sizes for significant differences between the delivery formats were small. Participants in videoconference groups tended to have slightly higher attendance rates in some instances, whereas functional improvement and treatment dropout were comparable across the delivery formats. Conclusions: Results provide preliminary evidence that videoconference group CBT for anxiety and related disorders may be a promising and effective alternative to face-to-face CBT. Additional research is needed to establish equivalence between these delivery formats.

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Online Attention Bias Modification in Combination With Cognitive-Behavioural Therapy for Children and Adolescents With Anxiety Disorders: A Randomised Controlled Trial

Behaviour Change ◽

10.1017/bec.2019.8 ◽

2019 ◽

Vol 36 (4) ◽

pp. 200-215 ◽

Cited By ~ 1

Author(s):

Jasmijn M. de Lijster ◽

Gwendolyn C. Dieleman ◽

Elisabeth M.W.J. Utens ◽

Jan van der Ende ◽

Tamsin M. Alexander ◽

...

Keyword(s):

Anxiety Disorder ◽

Anxiety Disorders ◽

Children And Adolescents ◽

Controlled Trial ◽

Attention Bias ◽

Behavioural Therapy ◽

Attention Bias Modification ◽

Cognitive Behavioural ◽

Secondary Outcomes ◽

Bias Modification

AbstractAttention Bias Modification (ABM) targets attention bias (AB) towards threat, which is common in youth with anxiety disorders. Previous clinical trials showed inconsistent results regarding the efficacy of ABM, and few studies have examined the effect of online ABM and its augmented effect with cognitive behavioural therapy (CBT). The aim of the current study was to examine the efficacy of online ABM combined with CBT for children and adolescents with anxiety disorders in a randomised, double-blind, placebo-controlled trial. Children (aged 8–16 years) completed nine online sessions of ABM (n= 28) or online sessions of the Attention Control Condition (ACC;n= 27) over a period of 3 weeks (modified dot-probe task with anxiety disorder-congruent stimuli), followed by CBT. Primary outcomes were clinician-reported anxiety disorder status. Secondary outcomes were patient-reported anxiety and depression symptoms and AB. Results showed a continuous decrease across time in primary and secondary outcomes (ps < .001). However, no differences across time between the ABM and ACC group were found (ps > .50). Baseline AB and age did not moderate treatment effects. Online ABM combined with CBT does not show different efficacy compared with online ACC with CBT for children and adolescents with anxiety disorders.

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Therapist-guided internet-delivered cognitive–behavioural therapy supplemented with group exposure sessions for adolescents with social anxiety disorder: a feasibility trial

BMJ Open ◽

10.1136/bmjopen-2017-018345 ◽

2017 ◽

Vol 7 (12) ◽

pp. e018345 ◽

Cited By ~ 13

Author(s):

Martina Nordh ◽

Sarah Vigerland ◽

Lars-Göran Öst ◽

Brjánn Ljótsson ◽

David Mataix-Cols ◽

...

Keyword(s):

Anxiety Disorder ◽

Social Anxiety ◽

Cognitive Behavioural Therapy ◽

Social Anxiety Disorder ◽

Behavioural Therapy ◽

Post Treatment ◽

Feasibility Trial ◽

Cognitive Behavioural ◽

Exposure Sessions

ObjectivesSocial anxiety disorder (SAD) is one of the most common psychiatric disorders in youth, with a prevalence of about 3%–4% and increased risk of adverse long-term outcomes, such as depression. Cognitive–behavioural therapy (CBT) is considered the first-line treatment for youth with SAD, but many adolescents remain untreated due to limited accessibility to CBT. The aim of this study was to develop and evaluate the feasibility and preliminary efficacy of a therapist-guided internet-delivered CBT treatment, supplemented with clinic-based group exposure sessions (BIP SOFT).DesignA proof-of-concept, open clinical trial with 6-month follow-up.ParticipantsThe trial was conducted at a child and adolescent psychiatric research clinic, and participants (n=30) were 13–17 years old (83% girls) with a principal diagnosis of SAD.Intervention12 weeks of intervention, consisting of nine remote therapist-guided internet-delivered CBT sessions and three group exposure sessions at the clinic for the adolescents and five internet-delivered sessions for the parents.ResultsAdolescents were generally satisfied with the treatment, and the completion rate of internet modules, as well as attendance at group sessions, was high. Post-treatment assessment showed a significant decrease in clinician-rated, adolescent-rated and parent-rated social anxiety (d=1.17, 0.85 and 0.79, respectively), as well as in general self-rated and parent-rated anxiety and depression (d=0.76 and 0.51), compared with pretreatment levels. Furthermore, 47% of participants no longer met Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria for SAD at post-treatment. At a 6-month follow-up, symptom reductions were maintained, or further improved, and 57% of participants no longer met criteria for SAD.ConclusionTherapist-guided and parent-guided internet-delivered CBT, supplemented with a limited number of group exposure sessions, is a feasible and promising intervention for adolescents with SAD.Trial registration numberNCT02576171; Results.

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Genome-wide association study of response to cognitive–behavioural therapy in children with anxiety disorders

The British Journal of Psychiatry ◽

10.1192/bjp.bp.115.168229 ◽

2016 ◽

Vol 209 (3) ◽

pp. 236-243 ◽

Cited By ~ 18

Author(s):

Jonathan R. I. Coleman ◽

Kathryn J. Lester ◽

Robert Keers ◽

Susanna Roberts ◽

Charles Curtis ◽

...

Keyword(s):

Anxiety Disorders ◽

Association Study ◽

Treatment Response ◽

Genome Wide Association Study ◽

Behavioural Therapy ◽

Post Treatment ◽

Genome Wide Association ◽

Genome Wide ◽

Cognitive Behavioural

BackgroundAnxiety disorders are common, and cognitive–behavioural therapy (CBT) is a first-line treatment. Candidate gene studies have suggested a genetic basis to treatment response, but findings have been inconsistent.AimsTo perform the first genome-wide association study (GWAS) of psychological treatment response in children with anxiety disorders (n = 980).MethodPresence and severity of anxiety was assessed using semi-structured interview at baseline, on completion of treatment (post-treatment), and 3 to 12 months after treatment completion (follow-up). DNA was genotyped using the Illumina Human Core Exome-12v1.0 array. Linear mixed models were used to test associations between genetic variants and response (change in symptom severity) immediately post-treatment and at 6-month follow-up.ResultsNo variants passed a genome-wide significance threshold (P=5×10–8) in either analysis. Four variants met criteria for suggestive significance (P<5×10–6) in association with response post-treatment, and three variants in the 6-month follow-up analysis.ConclusionsThis is the first genome-wide therapygenetic study. It suggests no common variants of very high effect underlie response to CBT. Future investigations should maximise power to detect single-variant and polygenic effects by using larger, more homogeneous cohorts.

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A Meta-Analysis of Transdiagnostic Cognitive Behavioural Therapy in the Treatment of Child and Young Person Anxiety Disorders

Behavioural and Cognitive Psychotherapy ◽

10.1017/s1352465813001094 ◽

2013 ◽

Vol 43 (5) ◽

pp. 562-577 ◽

Cited By ~ 27

Author(s):

Donna L. Ewing ◽

Jeremy J. Monsen ◽

Ellen J. Thompson ◽

Sam Cartwright-Hatton ◽

Andy Field

Keyword(s):

Anxiety Disorder ◽

Young People ◽

Anxiety Disorders ◽

Cognitive Behavioural Therapy ◽

Meta Analysis ◽

Behavioural Therapy ◽

Control Group ◽

Controlled Trials ◽

Children And Young People ◽

Cognitive Behavioural

Background: Previous meta-analyses of cognitive-behavioural therapy (CBT) for children and young people with anxiety disorders have not considered the efficacy of transdiagnostic CBT for the remission of childhood anxiety. Aim: To provide a meta-analysis on the efficacy of transdiagnostic CBT for children and young people with anxiety disorders. Methods: The analysis included randomized controlled trials using transdiagnostic CBT for children and young people formally diagnosed with an anxiety disorder. An electronic search was conducted using the following databases: ASSIA, Cochrane Controlled Trials Register, Current Controlled Trials, Medline, PsycArticles, PsychInfo, and Web of Knowledge. The search terms included “anxiety disorder(s)”, “anxi*”, “cognitive behavio*, “CBT”, “child*”, “children”, “paediatric”, “adolescent(s)”, “adolescence”, “youth” and “young pe*”. The studies identified from this search were screened against the inclusion and exclusion criteria, and 20 studies were identified as appropriate for inclusion in the current meta-analysis. Pre- and posttreatment (or control period) data were used for analysis. Results: Findings indicated significantly greater odds of anxiety remission from pre- to posttreatment for those engaged in the transdiagnostic CBT intervention compared with those in the control group, with children in the treatment condition 9.15 times more likely to recover from their anxiety diagnosis than children in the control group. Risk of bias was not correlated with study effect sizes. Conclusions: Transdiagnostic CBT seems effective in reducing symptoms of anxiety in children and young people. Further research is required to investigate the efficacy of CBT for children under the age of 6.

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The Association Between Maternal Anxiety and Treatment Outcome for Childhood Anxiety Disorders

Behaviour Change ◽

10.1375/bech.26.1.1 ◽

2009 ◽

Vol 26 (1) ◽

pp. 1-15 ◽

Cited By ~ 6

Author(s):

Natalie S. Gar ◽

Jennifer L. Hudson

Keyword(s):

Treatment Outcome ◽

Anxiety Disorder ◽

Childhood Anxiety ◽

Behavioural Therapy ◽

Primary Diagnosis ◽

Maternal Anxiety ◽

Diagnostic Data ◽

Childhood Anxiety Disorders ◽

Cognitive Behavioural

AbstractThis study examined the influence of maternal anxiety on the treatment outcome of anxious children. Forty-eight clinically anxious children (aged 6–14 years) were classified into two groups based on the presence of an anxiety disorder diagnosis in their mother. Diagnostic data at posttreatment showed that children with anxious mothers responded significantly less favourably to cognitive behavioural therapy (CBT) than did children with nonanxious mothers (28% vs. 58% improved, respectively). At 12-month follow-up, 68% of children with anxious mothers improved, compared to 79% of children with nonanxious mothers. This difference was not significant. Findings were not consistent across outcome measures. This study also investigated the changes in maternal anxiety across child treatment. Prior to treatment, diagnostic data showed that 60% of mothers met criteria for an anxiety disorder. At posttreatment, 21% of these mothers were free of their primary diagnosis. There was also a significant reduction in self-reported maternal anxiety across treatment that was maintained at follow-up. Theoretical and clinical implications of the findings are discussed.

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Non-replication of the association between 5HTTLPR and response to psychological therapy for child anxiety disorders

The British Journal of Psychiatry ◽

10.1192/bjp.bp.114.154997 ◽

2016 ◽

Vol 208 (2) ◽

pp. 182-188 ◽

Cited By ~ 16

Author(s):

Kathryn J. Lester ◽

Susanna Roberts ◽

Robert Keers ◽

Jonathan R. I. Coleman ◽

Gerome Breen ◽

...

Keyword(s):

Anxiety Disorders ◽

Child Anxiety ◽

Behavioural Therapy ◽

Short Allele ◽

Linear Mixed Effects ◽

Cognitive Behavioural ◽

Child Anxiety Disorders ◽

Positive Treatment ◽

The Relationship

BackgroundWe previously reported an association between 5HTTLPR genotype and outcome following cognitive–behavioural therapy (CBT) in child anxiety (Cohort 1). Children homozygous for the low-expression short-allele showed more positive outcomes. Other similar studies have produced mixed results, with most reporting no association between genotype and CBT outcome.AimsTo replicate the association between 5HTTLPR and CBT outcome in child anxiety from the Genes for Treatment study (GxT Cohort 2, n = 829).MethodLogistic and linear mixed effects models were used to examine the relationship between 5HTTLPR and CBT outcomes. Mega-analyses using both cohorts were performed.ResultsThere was no significant effect of 5HTTLPR on CBT outcomes in Cohort 2. Mega-analyses identified a significant association between 5HTTLPR and remission from all anxiety disorders at follow-up (odds ratio 0.45, P = 0.014), but not primary anxiety disorder outcomes.ConclusionsThe association between 5HTTLPR genotype and CBT outcome did not replicate. Short-allele homozygotes showed more positive treatment outcomes, but with small, non-significant effects. Future studies would benefit from utilising whole genome approaches and large, homogenous samples.

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Acceptability, effectiveness and cost-effectiveness of blended cognitive-behavioural therapy (bCBT) versus face-to-face CBT (ftfCBT) for anxiety disorders in specialised mental health care: A 15-week randomised controlled trial with 1-year follow-up

PLoS ONE ◽

10.1371/journal.pone.0259493 ◽

2021 ◽

Vol 16 (11) ◽

pp. e0259493

Author(s):

Geke Romijn ◽

Neeltje Batelaan ◽

Jeroen Koning ◽

Anton van Balkom ◽

Aart de Leeuw ◽

...

Keyword(s):

Mental Health ◽

Health Care ◽

Cost Effectiveness ◽

Anxiety Disorders ◽

Behavioural Therapy ◽

Face To Face ◽

Point Estimates ◽

Cognitive Behavioural ◽

One Year

Background Anxiety disorders are highly prevalent and cause substantial economic burden. Blended cognitive-behavioural therapy (bCBT), which integrates Internet-based CBT and face-to-face CBT (ftfCBT), is an attractive and potentially cost-saving treatment alternative to conventional CBT for patients with anxiety disorders in specialised mental health care. However, little is known about the effectiveness of bCBT in routine care. We examined the acceptability, effectiveness and cost-effectiveness of bCBT versus ftfCBT in outpatient specialised care to patients with panic disorder, social anxiety disorder and generalised anxiety disorder. Methods and findings Patients with anxiety disorders were randomised to bCBT (n = 52) or ftfCBT (n = 62). Acceptability of bCBT and ftfCBT were evaluated by assessing treatment preference, adherence, satisfaction and therapeutic alliance. Costs and effects were assessed at post-treatment and one-year follow-up. Primary outcome measure was the Beck Anxiety Inventory (BAI). Secondary outcomes were depressive symptoms, general psychopathology, work and social adjustment, quality of life and mastery. Incremental cost-effectiveness ratios (ICERs) were computed from societal and healthcare perspectives by calculating the incremental costs per incremental quality-adjusted life year (QALY). No significant differences between bCBT and ftfCBT were found on acceptability or effectiveness measures at post-treatment (Cohen’s d between-group effect size on BAI = 0.15, 95% CI −0.30 to 0.60) or at one-year follow-up (d = −0.38, 95% CI −0.84 to 0.09). The modelled point estimates of societal costs (bCBT €10945, ftfCBT €10937) were higher and modelled point estimates of direct medical costs (bCBT €3748, ftfCBT €3841) were lower in bCBT. The acceptability curves showed that bCBT was expected to be a cost-effective intervention. Results should be carefully interpreted due to the small sample size. Conclusions bCBT appears an acceptable, clinically effective and potentially cost-saving alternative option for treating patients with anxiety disorders. Trials with larger samples are needed to further investigate cost-effectiveness. Trial registration Netherlands Trial Register: NTR4912.

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Enduring effects of psychological treatments for anxiety disorders: meta-analysis of follow-up studies

The British Journal of Psychiatry ◽

10.1192/bjp.2018.49 ◽

2018 ◽

Vol 212 (6) ◽

pp. 333-338 ◽

Cited By ~ 13

Author(s):

Borwin Bandelow ◽

Anne Sagebiel ◽

Michael Belz ◽

Yvonne Görlich ◽

Sophie Michaelis ◽

...

Keyword(s):

Anxiety Disorder ◽

Anxiety Disorders ◽

Cognitive Behavioural Therapy ◽

Psychological Treatment ◽

Meta Analysis ◽

Behavioural Therapy ◽

Control Groups ◽

Cognitive Behavioural ◽

Significant Difference

BackgroundIt is a widespread opinion that after treatment with psychotherapy, patients with anxiety disorders maintain their gains beyond the active treatment period, whereas patients treated with medication soon experience a relapse after treatment termination.AimsWe aimed to provide evidence on whether enduring effects of psychotherapy differ from control groups.MethodWe searched 93 randomised controlled studies with 152 study arms of psychological treatment (cognitive–behavioural therapy or other psychotherapies) for panic disorder, generalised anxiety disorder and social anxiety disorder that included follow-up assessments. In a meta-analysis, pre-post effect sizes for end-point and all follow-up periods were calculated and compared with control groups (medication: n = 16 study arms; pill and psychological placebo groups: n = 17 study arms).ResultsGains with psychotherapy were maintained for up to 24 months. For cognitive–behavioural therapy, we observed a significant improvement over time. However, patients in the medication group remained stable during the treatment-free period, with no significant difference when compared with psychotherapy. Patients in the placebo group did not deteriorate during follow-up, but showed significantly worse outcomes than patients in cognitive–behavioural therapy.ConclusionsNot only psychotherapy, but also medications and, to a lesser extent, placebo conditions have enduring effects. Long-lasting treatment effects observed in the follow-up period may be superimposed by effects of spontaneous remission or regression to the mean.Declaration of interestIn the past 12 months and in the near future, Dr Bandelow has been/will be on the speakers/advisory board for Hexal, Mundipharma, Lilly, Lundbeck, Pfizer and Servier. Dr Wedekind was on the speakers' board of AstraZeneca, Essex Pharma, Lundbeck and Servier. All other authors have nothing to declare.

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Using a Smartphone App and Clinician Portal to Enhance Brief Cognitive Behavioral Therapy for Childhood Anxiety Disorders

10.31234/osf.io/pyeq4 ◽

2019 ◽

Cited By ~ 1

Author(s):

Jennifer Susan Silk ◽

Gede Pramana ◽

Stefanie Sequeira ◽

Oliver Lindhiem ◽

Philip C. Kendall ◽

...

Keyword(s):

Anxiety Disorder ◽

Cognitive Behavioral Therapy ◽

Anxiety Disorders ◽

Behavioral Therapy ◽

Controlled Trial ◽

Child Anxiety ◽

Childhood Anxiety ◽

Post Treatment ◽

Cognitive Behavioral ◽

Childhood Anxiety Disorders

Cognitive behavioral therapy (CBT) is an efficacious treatment for child anxiety disorders, but 40-50% of youth do not respond fully to treatment, and time commitments for standard CBT can be prohibitive for some families and lead to long waiting lists for trained CBT therapists in the community. SmartCAT 2.0 is an adjunctive mobile health program designed to improve and shorten CBT treatment for anxiety disorders in youth by providing them with the opportunity to practice CBT skills outside of session using an interactive and gamified interface. It consists of an app and an integrated clinician portal connected to the app for secure 2-way communication with the therapist. The goal of the present study was to evaluate SmartCAT 2.0 in an open trial to establish usability, feasibility, acceptability, and preliminary efficacy of brief (8 sessions) CBT combined with SmartCAT. We also explored changes in CBT skills targeted by the app. Participants were 34 youth (ages 9-14) who met DSM-5 criteria for generalized, separation, and/or social anxiety disorder. Results demonstrated strong feasibility and usability of the app/portal and high satisfaction with the intervention. Youth used the app an average of 12 times between each therapy session (M = 5.8 mins per day). At post-treatment, 67% of youth no longer met diagnostic criteria for an anxiety disorder, with this percentage increasing to 86% at two-month follow-up. Youth showed reduced symptom severity over time across raters and also improved from pre- to post-treatment in CBT skills targeted by the app, demonstrating better emotion identification and thought challenging and reductions in avoidance. Findings support the feasibility of combining brief CBT with SmartCAT. Although not a controlled trial, when benchmarked against the literature, the current findings suggest that SmartCAT may enhance the utility of brief CBT for childhood anxiety disorders. This paper is currently in press in Behavior Therapy.

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