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van Steensel FJA, Telman LGE, Maric M, Bögels SM. Modular CBT for Childhood Anxiety Disorders: Evaluating Clinical Outcomes and its Predictors. Child Psychiatry Hum Dev 2024; 55:790-801. [PMID: 36192529 PMCID: PMC11061043 DOI: 10.1007/s10578-022-01437-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/04/2022] [Indexed: 11/03/2022]
Abstract
This study examined clinical outcomes of a modular individual CBT for children with anxiety disorders (AD), and predictors of outcomes, in usual clinical practice. Participants were 106 children with ADs (7-17 years), and parents. Assessments were pre-, mid-, post-test, and 10 weeks after CBT (follow-up). Predictors (measured pre-treatment) were child characteristics (gender, age, type of AD, comorbid disorders), fathers' and mothers' anxious/depressive symptoms, and parental involvement (based on parents' presence during treatment sessions and the use of a parent module in treatment). At follow-up, 59% (intent-to-treat analyses) to 70% (completer analysis) of the children were free from their primary anxiety disorder. A significant decrease in anxiety symptoms was found. Higher parental involvement was related to lower child anxiety at follow-up, but only for children with comorbid disorders. Findings suggest that it is beneficial to treat anxiety with modular CBT. Future steps involve comparisons of modularized CBT with control conditions.
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Affiliation(s)
- Francisca J A van Steensel
- Research Institute of Child Development and Education, University of Amsterdam, Nieuwe Achtergracht 127, Postbus 15776, 1001 NG, 1018 WS, Amsterdam, The Netherlands.
| | - Liesbeth G E Telman
- Research Institute of Child Development and Education, University of Amsterdam, Nieuwe Achtergracht 127, Postbus 15776, 1001 NG, 1018 WS, Amsterdam, The Netherlands
- Department of Clinical Child and Family Studies, Utrecht University, P.O. Box 80140, TC 3508, Utrecht, The Netherlands
| | - M Maric
- Research Institute of Child Development and Education, University of Amsterdam, Nieuwe Achtergracht 127, Postbus 15776, 1001 NG, 1018 WS, Amsterdam, The Netherlands
- Department of Developmental Psychology, University of Amsterdam, Nieuwe Achtergracht 127, 1018 WS, Amsterdam, The Netherlands
| | - Susan M Bögels
- Research Institute of Child Development and Education, University of Amsterdam, Nieuwe Achtergracht 127, Postbus 15776, 1001 NG, 1018 WS, Amsterdam, The Netherlands
- Department of Developmental Psychology, University of Amsterdam, Nieuwe Achtergracht 127, 1018 WS, Amsterdam, The Netherlands
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2
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Wuthrich VM, Zagic D, Dickson SJ, McLellan LF, Chen JTH, Jones MP, Rapee RM. Effectiveness of Psychotherapy for Internalising Symptoms in Children and Adolescents When Delivered in Routine Settings: A Systematic Review and Meta-analysis. Clin Child Fam Psychol Rev 2023; 26:824-848. [PMID: 37059918 PMCID: PMC10465434 DOI: 10.1007/s10567-023-00433-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2023] [Indexed: 04/16/2023]
Abstract
This systematic review and meta-analysis aimed to examine the effectiveness of psychological interventions for internalising disorders in youth when delivered in routine settings. Secondary aims were to examine the effectiveness of cognitive behavioural therapy and determine moderators of treatment response. The study was pre-registered (PROSPERO 2020 CRD42020202776). Databases were systematically searched (PsycINFO, Medline, Embase, PubMed, ERIC) in December 2022 and screened according to the PRISMA 2020 statement. Inclusion: School aged participants (4-18 years) with a primary internalising disorder; psychotherapy delivered in a routine setting (e.g. outpatient clinic, school) by setting staff; compared psychotherapy to any control in a randomised controlled trial; reported pre-to-post or pre-to-follow-up comparisons on the primary disorder according to child, parent or independent evaluator report; and was published in English. Risk of bias was assessed using the ROB 2.0 Cochrane tool. Results were synthesised using random effects to pool estimates. Risk ratios were used to analyse dichotomous data and standardised mean differences (SMD) for continuous data. Forty-five studies were included (N = 4901 participants; M = 13 years; range 8-16; SD = 2.5). Nine used waitlist control, 17 treatment as usual, 4 placebo; 15 compared psychotherapy to active control. Psychotherapy was associated with small significant effects pre- to post-treatment compared to non-active controls for anxiety (SMD = - 0.24 to 0.50) and depression (SMD = - 0.19 to 0.34) with effects differing by informant. Psychotherapy led to small significant pre-to-post-benefits in youth internalising disorders in routine settings. Results are limited by reporter type and follow-up.
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Affiliation(s)
- Viviana M Wuthrich
- Centre for Emotional Health, School of Psychological Sciences, Macquarie University, Sydney, 2109, Australia.
| | - Dino Zagic
- Centre for Emotional Health, School of Psychological Sciences, Macquarie University, Sydney, 2109, Australia
| | - Sophie J Dickson
- Centre for Emotional Health, School of Psychological Sciences, Macquarie University, Sydney, 2109, Australia
| | - Lauren F McLellan
- Centre for Emotional Health, School of Psychological Sciences, Macquarie University, Sydney, 2109, Australia
| | - Jessamine T-H Chen
- Centre for Emotional Health, School of Psychological Sciences, Macquarie University, Sydney, 2109, Australia
| | - Michael P Jones
- Centre for Emotional Health, School of Psychological Sciences, Macquarie University, Sydney, 2109, Australia
| | - Ronald M Rapee
- Centre for Emotional Health, School of Psychological Sciences, Macquarie University, Sydney, 2109, Australia
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3
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Lewis KM, Barrett P, Freitag G, Ollendick TH. An Ounce of Prevention: Building resilience and targeting anxiety in young children. Clin Child Psychol Psychiatry 2023; 28:795-809. [PMID: 35996946 DOI: 10.1177/13591045221121595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Anxiety disorders are among the most common psychiatric disorders in childhood and can develop as early as the preschool years. Therefore, providing young children who display early signs of anxiety with skills to prevent the development of later psychopathology is invaluable. The current study evaluates the effectiveness of Fun FRIENDS, an anxiety prevention and resilience program for young children. METHOD Fifty-seven kindergartners across three classrooms participated in a 15-week anxiety prevention program and teachers completed a behavioral screening measure and anxiety questionnaire at pre, post, 3 month, and 10-month follow-up assessment points. RESULTS Anxiety positively correlated with emotional symptoms, peer difficulties, and total difficulties at pre-intervention. Anxiety symptoms decreased from pre-intervention to follow-up. Additionally, prosocial behaviors improved and moderated the relationship between pre-and post-intervention anxiety symptoms. CONCLUSIONS These findings yield promising implications regarding the effectiveness of prevention and intervention programs on increasing social emotional skills and reducing anxiety symptoms in young children.
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Affiliation(s)
- Krystal M Lewis
- 25944National Institute of Mental Health, Bethesda, MD, USA.,Department of Psychology, 1757Virginia Polytechnic Institute and State University, Blacksburg, VA, USA
| | - Paula Barrett
- 2219Australian National University, Canberra, ACT, Australia
| | - Gabrielle Freitag
- Department of Psychology, 5450Florida International University, Miami, FL, USA
| | - Thomas H Ollendick
- Department of Psychology, 1757Virginia Polytechnic Institute and State University, Blacksburg, VA, USA
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4
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Kendall PC, Ney JS, Maxwell CA, Lehrbach KR, Jakubovic RJ, McKnight DS, Friedman AL. Adapting CBT for youth anxiety: Flexibility, within fidelity, in different settings. Front Psychiatry 2023; 14:1067047. [PMID: 36937729 PMCID: PMC10014836 DOI: 10.3389/fpsyt.2023.1067047] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 01/30/2023] [Indexed: 03/05/2023] Open
Abstract
Anxiety disorders are common in youth, associated with impairments in daily functioning, and often persist into adulthood when untreated. Cognitive behavioral therapy (CBT) for youth anxiety is a well-established intervention and has been modified to fit several treatment settings. Despite decades of results supporting the efficacy of CBT, there is a large gap in access to this treatment and a need to consider how it can best be administered flexibly to increase uptake and personalization. We first discuss the core components of treatment for CBT through the lens of the Coping Cat treatment. Next, we review the empirical findings regarding adjustments made for CBT for youth anxiety delivered (a) in schools, (b) in community settings, (c) through telehealth, (d) through online computer programs, and (e) by caregivers at home. In each setting, we provide specific suggestions for how to implement CBT with flexibility while maintaining fidelity.
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5
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Smith SN, Almirall D, Choi SY, Koschmann E, Rusch A, Bilek E, Lane A, Abelson JL, Eisenberg D, Himle JA, Fitzgerald KD, Liebrecht C, Kilbourne AM. Primary aim results of a clustered SMART for developing a school-level, adaptive implementation strategy to support CBT delivery at high schools in Michigan. Implement Sci 2022; 17:42. [PMID: 35804370 PMCID: PMC9264291 DOI: 10.1186/s13012-022-01211-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 05/11/2022] [Indexed: 11/10/2022] Open
Abstract
Background Schools increasingly provide mental health services to students, but often lack access to implementation strategies to support school-based (and school professional [SP]) delivery of evidence-based practices. Given substantial heterogeneity in implementation barriers across schools, development of adaptive implementation strategies that guide which implementation strategies to provide to which schools and when may be necessary to support scale-up. Methods A clustered, sequential, multiple-assignment randomized trial (SMART) of high schools across Michigan was used to inform the development of a school-level adaptive implementation strategy for supporting SP-delivered cognitive behavioral therapy (CBT). All schools were first provided with implementation support informed by Replicating Effective Programs (REP) and then were randomized to add in-person Coaching or not (phase 1). After 8 weeks, schools were assessed for response based on SP-reported frequency of CBT delivered to students and/or barriers reported. Responder schools continued with phase 1 implementation strategies. Slower-responder schools (not providing ≥ 3 CBT components to ≥10 students or >2 organizational barriers identified) were re-randomized to add Facilitation to current support or not (phase 2). The primary aim hypothesis was that SPs at schools receiving the REP + Coaching + Facilitation adaptive implementation strategy would deliver more CBT sessions than SPs at schools receiving REP alone. Secondary aims compared four implementation strategies (Coaching vs no Coaching × Facilitation vs no Facilitation) on CBT sessions delivered, including by type (group, brief and full individual). Analyses used a marginal, weighted least squares approach developed for clustered SMARTs. Results SPs (n = 169) at 94 high schools entered the study. N = 83 schools (88%) were slower-responders after phase 1. Contrary to the primary aim hypothesis, there was no evidence of a significant difference in CBT sessions delivered between REP + Coaching + Facilitation and REP alone (111.4 vs. 121.1 average total CBT sessions; p = 0.63). In secondary analyses, the adaptive strategy that offered REP + Facilitation resulted in the highest average CBT delivery (154.1 sessions) and the non-adaptive strategy offering REP + Coaching the lowest (94.5 sessions). Conclusions The most effective strategy in terms of average SP-reported CBT delivery is the adaptive implementation strategy that (i) begins with REP, (ii) augments with Facilitation for slower-responder schools (schools where SPs identified organizational barriers or struggled to deliver CBT), and (iii) stays the course with REP for responder schools. Trial registration ClinicalTrials.gov, NCT03541317, May 30, 2018. Supplementary Information The online version contains supplementary material available at 10.1186/s13012-022-01211-w.
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Affiliation(s)
- Shawna N Smith
- Department of Health Management and Policy, School of Public Health, University of Michigan, SPH II, 1415 Washington Heights, Ann Arbor, MI, 48109, USA. .,Department of Psychiatry, Michigan Medicine, University of Michigan, Ann Arbor, USA.
| | - Daniel Almirall
- Survey Research Center, Institute of Social Research, University of Michigan, Ann Arbor, USA.,Department of Statistics, University of Michigan, Ann Arbor, USA
| | - Seo Youn Choi
- Department of Health Management and Policy, School of Public Health, University of Michigan, SPH II, 1415 Washington Heights, Ann Arbor, MI, 48109, USA
| | - Elizabeth Koschmann
- Department of Psychiatry, Michigan Medicine, University of Michigan, Ann Arbor, USA
| | - Amy Rusch
- Department of Health Management and Policy, School of Public Health, University of Michigan, SPH II, 1415 Washington Heights, Ann Arbor, MI, 48109, USA
| | - Emily Bilek
- Department of Psychiatry, Michigan Medicine, University of Michigan, Ann Arbor, USA
| | - Annalise Lane
- Department of Health Management and Policy, School of Public Health, University of Michigan, SPH II, 1415 Washington Heights, Ann Arbor, MI, 48109, USA
| | - James L Abelson
- Department of Psychiatry, Michigan Medicine, University of Michigan, Ann Arbor, USA
| | - Daniel Eisenberg
- Department of Health Policy and Management, UCLA, Los Angeles, USA
| | - Joseph A Himle
- Department of Psychiatry, Michigan Medicine, University of Michigan, Ann Arbor, USA.,School of Social Work, University of Michigan, Ann Arbor, USA
| | - Kate D Fitzgerald
- Department of Psychiatry, Columbia University Irving Medical Center/New York State Psychiatric Institute, New York City, USA
| | - Celeste Liebrecht
- Department of Learning Health Sciences, Michigan Medicine, University of Michigan, Ann Arbor, USA
| | - Amy M Kilbourne
- Department of Learning Health Sciences, Michigan Medicine, University of Michigan, Ann Arbor, USA.,Quality Enhancement Research Initiative (QUERI), US Department of Veterans Affairs, Washington, D.C., USA
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6
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Petersen JM, Davis CH, Renshaw TL, Levin ME, Twohig MP. School-Based Acceptance and Commitment Therapy for Adolescents With Anxiety: A Pilot Trial. COGNITIVE AND BEHAVIORAL PRACTICE 2022. [DOI: 10.1016/j.cbpra.2022.02.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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7
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Armusewicz K, Steele M, Steele H, Murphy A. Assessing therapist and clinician competency in parent-infant psychotherapy: The REARING coding system (RCS) for the group attachment based intervention (GABI). RESEARCH IN PSYCHOTHERAPY (MILANO) 2022; 25:562. [PMID: 35373964 PMCID: PMC9153755 DOI: 10.4081/ripppo.2022.562] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 02/11/2022] [Indexed: 06/14/2023]
Abstract
The development of fidelity and quality measures for the dissemination of evidence-based practices is an often-neglected, vital step in the implementation of psychological interventions, especially within parent-infant mental health. The current study aims to address this gap by developing a competency-based measure for clinicians delivering the Group Attachment Based Intervention (GABI). GABI is an intervention aimed at supporting family preservation in parents who have experienced disparities across multiple systems of care. After observing over 100 hours of clinical video, the research team, comprised of clinicians and academic researchers, developed a competency coding system to measure clinician efficacy titled the REARING coding system (RCS). This paper outlines the development and structure of the measure, including a detailed discussion of the model of therapeutic action (i.e., REARING: reflective functioning, emotional attunement, affect regulation, reticence, intergenerational transmission of attachment, nurturance, and group therapy context), as well as provides a clinical case study to illustrate the utility, flexibility, and depth of the measure. The case study details a family session consisting of a mother, father, and two children (one infant, one toddler), and how RCS can be used in supervision to foster clinical competency and effectiveness in the GABI model. RCS seeks to address the dissemination gap in Evidence Based Practices (EBPs) by contributing to the limited number of existing fidelity and competency measures in infant mental health and psychodynamic dyadic psychotherapy. RCS is an important tool for monitoring clinical competency in the dissemination of GABI and gives supervisors the ability to provide fidelity-focused supervisions.
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Affiliation(s)
- Kelsey Armusewicz
- Rose F. Kennedy Children's Evaluation and Rehabilitation Center, Montefiore Medical Center, New York, NY.
| | | | | | - Anne Murphy
- Rose F. Kennedy Children's Evaluation and Rehabilitation Center, Montefiore Medical Center, New York, NY.
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8
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Rosen TE, Pickard K, Ponomaryova A, Kerns CM, Reaven J. From Clinic to Classroom: Two Case Studies of Youth With ASD and Anxiety From the School-Based Facing Your Fears Program. J Cogn Psychother 2022; 36:24-41. [PMID: 35121677 DOI: 10.1891/jcpsy-d-20-00051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Cognitive behavioral therapy (CBT) is considered best practice for treating anxiety in youth with autism spectrum disorder (ASD) in clinic settings. However, there is significant need to translate CBT into school settings. This paper presents two case illustrations of students who participated in the Facing Your Fears: School-Based program (FYF-SB), a manualized, group CBT intervention for anxiety in ASD, adapted for delivery in schools by interdisciplinary school providers. Students showed improvement in anxiety across multiple domains following intervention, according to clinical interview and parent- and self-report. These outcomes suggest that anxious youth with ASD can benefit from CBT delivered by interdisciplinary school providers. Importantly, decreases in anxiety symptoms were evident in domains that were not explicitly targeted during intervention. Overall, these case illustrations help frame areas of future research, including examining how treatment gains may generalize across anxiety domains as well as whether corresponding improvement in school functioning occurs.
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Affiliation(s)
- Tamara E Rosen
- JFK Partners, Department of Psychiatry and Pediatrics, University of Colorado, Aurora, Colorado, USA
| | - Katherine Pickard
- Marcus Autism Center, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Anastasiya Ponomaryova
- Department of Psychiatry and Behavioral Sciences, Montefiore Hospital/Albert Einstein College of Medicine, Bronx, New York, USA
| | - Connor M Kerns
- Department of Psychology, University of British Columbia, Vancouver, BC, Canada
| | - Judy Reaven
- JFK Partners, Department of Psychiatry and Pediatrics, University of Colorado, Aurora, Colorado, USA
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9
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Pickard K, Meyer A, Reyes N, Tanda T, Reaven J. Using evaluative frameworks to examine the implementation outcomes of a cognitive behavioral therapy program for autistic students with anxiety within public school settings. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2021; 26:640-653. [PMID: 34961348 DOI: 10.1177/13623613211065797] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
LAY ABSTRACT Cognitive behavioral therapy helps to treat anxiety symptoms in autistic youth, but it is difficult for families to access cognitive behavioral therapy in the community. Training school providers to deliver cognitive behavioral therapy may help autistic youth and their families to access these programs. Unfortunately, we do not know how cognitive behavioral therapy programs can be delivered by school providers and how these programs help the autistic students who access them. This study addressed this gap and was part of a larger study that looked at the effectiveness of Facing Your Fears-School-Based in 25 public schools. The study goals were to understand whether Facing Your Fears-School-Based helped students and the factors that made it easy or difficult to deliver Facing Your Fears-School-Based in schools. Thirty providers participated in interviews guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework. Participants shared information that fell into several major categories that included (1) delivering Facing Your Fears-School-Based to many different students; (2) the positive impact of Facing Your Fears-School-Based on students' school participation; and (3) plans to continue using Facing Your Fears-School-Based. School providers also shared that Facing Your Fears-School-Based was easy to use for non-mental health providers and reported adapting Facing Your Fears-School-Based to meet student needs. The results of this study suggest that Facing Your Fears-School-Based may help autistic students and highlight the importance of using mental health programs in schools that are flexible, able to be adapted, and that are able to be used by many different types of school providers.
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Affiliation(s)
- Katherine Pickard
- University of Colorado Anschutz Medical Campus, USA.,Emory School of Medicine, USA
| | | | - Nuri Reyes
- University of Colorado Anschutz Medical Campus, USA
| | - Tanea Tanda
- University of Colorado Anschutz Medical Campus, USA
| | - Judy Reaven
- University of Colorado Anschutz Medical Campus, USA
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10
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Assessment and treatment of anxiety in children and adolescents with ASD: a systematic review. ADVANCES IN AUTISM 2021. [DOI: 10.1108/aia-03-2021-0016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The purpose of this study was to investigate the quality of current studies that assess and treat anxiety symptoms in children with autism spectrum disorder (ASD). More specifically the study aimed to answer the following questions: What are the qualities of the current studies using cognitive behavioral therapies (CBTs) to treat anxiety symptoms in children with ASD? Did studies make necessary modifications and adaptations to CBTs according to the evidence-based strategies and implement these versions of CBTs with precise fidelity? Were the selected measurements appropriate for assessing the anxiety symptoms in children with ASD?
Design/methodology/approach
A systematic review protocol was developed from the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (Moher et al., 2009). A rubric was adapted based on the CEC (Council for Exceptional Children; Cook, 2014) group comparison studies standards and the Evaluative Method for Determining EBP in Autism (Reichow et al., 2007). The 3-point Likert Scale (Chard et al., 2009) was adapted to score each study based on the rubric.
Findings
CBT is a first-line treatment with significant mixed results. Current studies use adapted versions of existing CBTs for children with ASD without reporting empirical evidence to these adaptations and changes. Reporting of the implementation fidelity is still an issue in the treatment of anxiety. Anxiety measurements that were designed for typically developing children failure to detect unusual anxiety symptoms in children with ASD.
Research limitations/implications
The first limitation of this study was including a variety of studies across CBT programs and types of anxiety symptoms. Types of anxiety and CBT treatments may require separate analyses with specific indicators. Due to the limited studies, reviews could not be analyzed across types of CBT programs. The second limitation was the types of studies. Most of the studies were pilot studies. Pilot studies might use various instruments and CBTs components for making selections to produce the best effects and results. The final limitation was the lack of examination of the data analysis process.
Originality/value
These findings are important because due to the variety of changes or adaptation to CBTs, inappropriate implementations and failure to detect unusual anxiety symptoms of children with ASD may cause significant differences in treatment responses and outcomes. The study demonstrated that the majority of the studies used adapted versions of existing CBTs without reporting empirical evidence for these adaptations and changes. The findings have shown that reporting of the implementation fidelity is still an issue. Moreover, the majority of studies had used anxiety measurements that were designed for typically developing children, not for children with ASD.
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11
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Whiteside SPH, Sim LA, Morrow AS, Farah WH, Hilliker DR, Murad MH, Wang Z. A Meta-analysis to Guide the Enhancement of CBT for Childhood Anxiety: Exposure Over Anxiety Management. Clin Child Fam Psychol Rev 2021; 23:102-121. [PMID: 31628568 DOI: 10.1007/s10567-019-00303-2] [Citation(s) in RCA: 77] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Cognitive behavior therapy (CBT) is the most empirically supported therapy for childhood anxiety disorders (CADs) but has not reliably outperformed other credible interventions. The current study used meta-analysis to examine the frequency with which the most common treatment components are included in outcome studies and the relation of these components to symptom improvement. Seventy-five studies were identified that included youth with an anxiety disorder treated with CBT or a comparison condition. The protocols for the 111 CBT conditions generally consisted of 12, 1-h sessions delivered to the child with minimal parent inclusion. A greater amount of in-session exposure was related to significantly larger effect sizes between CBT and waitlist control across reporters (- 0.12 to - 0.15; P's < .05) and from pre- to post-treatment for child report (- .06; P < .01). Compared to treatments that omitted relaxation, treatments that included relaxation strategies were associated with significantly smaller pre- to post-treatment effect sizes across reporters (0.38 to 0.80; P's < .05). The current study suggests that CBT protocols for CADs that emphasize in-session exposure and do not include relaxation have the potential to improve the efficacy and effectiveness of therapy. Dismantling studies directly testing these hypotheses are needed.
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Affiliation(s)
- Stephen P H Whiteside
- Department of Psychiatry and Psychology, Mayo Clinic, Mayo Bldg West 11, 200 First St., SW, Rochester, MN, 55905, USA.
| | - Leslie A Sim
- Department of Psychiatry and Psychology, Mayo Clinic, Mayo Bldg West 11, 200 First St., SW, Rochester, MN, 55905, USA
| | - Allison S Morrow
- Robert D. and Patricia E. Kern Center for Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Wigdan H Farah
- Robert D. and Patricia E. Kern Center for Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Daniel R Hilliker
- Department of Psychiatry and Psychology, Mayo Clinic, Mayo Bldg West 11, 200 First St., SW, Rochester, MN, 55905, USA
| | - M Hassan Murad
- Robert D. and Patricia E. Kern Center for Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Zhen Wang
- Robert D. and Patricia E. Kern Center for Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
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12
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Treatment Fidelity in Brief Versus Standard-Length School-Based Interventions for Youth with Anxiety. SCHOOL MENTAL HEALTH 2021. [DOI: 10.1007/s12310-021-09458-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
AbstractTo examine treatment fidelity in a randomized controlled trial of indicated school-based cognitive-behavioral therapy (CBT) delivered in groups to youth with anxiety. We investigated whether adherence and competence (a) differed across brief and standard-length CBT, and (b) if adherence and competence predicted change in anxiety symptoms and impairment. Method: Sessions were observationally coded with the Competence and Adherence Scale for CBT for Anxiety Disorders in Youth. Coders (N = 7) rated 104 sessions from 52 groups delivered by 32 facilitators (M age = 43.2 years, SD = 8.1) to 295 youth (M age = 14.0 years, SD = 0.8). Outcomes were youth- and parent-reported anxiety symptoms and impairment at post-intervention and 1-year follow-up. Linear mixed effect models were used to analyze whether fidelity predicted clinical outcomes. Results: Levels of adherence and competence were adequate in both programs, but higher in brief compared to standard-length CBT p < .001 and p = .010, respectively). Neither adherence nor competence predicted clinical outcomes at any timepoints. Conclusion: Higher levels of adherence and competence in brief CBT suggest that it may be easier for novice CBT providers to achieve fidelity in simplified and less flexible interventions. Contrary to expectation, adherence and competence did not predict clinical outcomes.
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13
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Vu BT, Bosmans G. Psychological impact of COVID-19 anxiety on learning burnout in Vietnamese students. SCHOOL PSYCHOLOGY INTERNATIONAL 2021. [DOI: 10.1177/01430343211013875] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
It is becoming clear that the COVID-19 pandemic has had a devastating psychological impact on Vietnamese society, but little is known about its impact on Vietnamese students. In the current study, we evaluated whether anxiety of contracting COVID-19 is related to students’ learning burnout. Specifically, we tested two months into the pandemic whether this anxiety is linked to pupils’ learning exhaustion and cynicism. The data includes 652 Vietnamese students (56.3% girls) with Mage = 12.6 ( SD = 1.0). The data were collected using a self-report questionnaire during an online survey. Two Multiple Linear Regression Analyses tested the associations between COVID-19 anxiety and learning-related exhaustion (Model 1) and learning-related cynicism (Model 2), controlling for general depression, gender and grade. Results show that COVID-19 anxiety significantly and uniquely links to learning-related cynicism but not learning exhaustion, suggesting that the pandemic affects Vietnamese students’ ability to thrive through education.
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Affiliation(s)
- Ba Tuan Vu
- Hanoi National University of Education, Vietnam; KU Leuven, Belgium
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Kunas SL, Lautenbacher LM, Lueken PU, Hilbert K. Psychological Predictors of Cognitive-Behavioral Therapy Outcomes for Anxiety and Depressive Disorders in Children and Adolescents: A Systematic Review and Meta-Analysis. J Affect Disord 2021; 278:614-626. [PMID: 33035949 DOI: 10.1016/j.jad.2020.09.092] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 06/15/2020] [Accepted: 09/21/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND By understanding specific differences between responders to a treatment and non-responders, treatment modalities may be fitted to the individual in order to increase effectiveness, a concept known as "precision medicine". This systematic review and meta-analysis investigated which pretreatment patient and family characteristics may predict the outcome of cognitive-behavioral therapy (CBT) in clinically anxious and/or depressed youth. In particular, higher symptom severity, more severe co-occurring anxiety or depression and more severe parental psychopathology were hypothesized to predict a worse CBT outcome. METHODS The databases PubMed, PsycINFO and Cochrane Library were searched; 73 publications were included in the review from which 23 studies were used for the meta-analysis. RESULTS Higher symptom severity represented a clinically relevant predictor of a worse CBT outcome, with large effects estimated by meta-analysis. Further, parental psychopathology was significant and detrimental for CBT outcome in anxious but not depressed youth, while the effects for co-occurring anxiety and depression remained unclear. The additional results of the review show that only few characteristics seemed to be clearly associated with a worse CBT outcome, namely worse coping skills and, restricted to depressed patients, more non-suicidal self-injury. LIMITATIONS The available evidence was of only moderate quality in general, further high-quality research with more transparent reporting is needed. CONCLUSIONS The patient characteristics identified as being relevant for CBT outcome may represent important candidates for use in single patient prediction models for precision medicine in the field of child and adolescent psychotherapy. The review was preregistered on PROSPERO (ID: CRD42018116881).
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Affiliation(s)
- Stefanie L Kunas
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany; Psychologische Hochschule Berlin, Berlin, Germany.
| | | | | | - Kevin Hilbert
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
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15
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James AC, Reardon T, Soler A, James G, Creswell C. Cognitive behavioural therapy for anxiety disorders in children and adolescents. Cochrane Database Syst Rev 2020; 11:CD013162. [PMID: 33196111 PMCID: PMC8092480 DOI: 10.1002/14651858.cd013162.pub2] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Previous Cochrane Reviews have shown that cognitive behavioural therapy (CBT) is effective in treating childhood anxiety disorders. However, questions remain regarding the following: up-to-date evidence of the relative efficacy and acceptability of CBT compared to waiting lists/no treatment, treatment as usual, attention controls, and alternative treatments; benefits across a range of outcomes; longer-term effects; outcomes for different delivery formats; and amongst children with autism spectrum disorders (ASD) and children with intellectual impairments. OBJECTIVES To examine the effect of CBT for childhood anxiety disorders, in comparison with waitlist/no treatment, treatment as usual (TAU), attention control, alternative treatment, and medication. SEARCH METHODS We searched the Cochrane Common Mental Disorders Controlled Trials Register (all years to 2016), the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, and PsycINFO (each to October 2019), international trial registries, and conducted grey literature searches. SELECTION CRITERIA We included randomised controlled trials of CBT that involved direct contact with the child, parent, or both, and included non-CBT comparators (waitlist/no treatment, treatment as usual, attention control, alternative treatment, medication). Participants were younger than age 19, and met diagnostic criteria for an anxiety disorder diagnosis. Primary outcomes were remission of primary anxiety diagnosis post-treatment, and acceptability (number of participants lost to post-treatment assessment), and secondary outcomes included remission of all anxiety diagnoses, reduction in anxiety symptoms, reduction in depressive symptoms, improvement in global functioning, adverse effects, and longer-term effects. DATA COLLECTION AND ANALYSIS We used standard methodological procedures as recommended by Cochrane. We used GRADE to assess the quality of the evidence. MAIN RESULTS We included 87 studies and 5964 participants in quantitative analyses. Compared with waitlist/no treatment, CBT probably increases post-treatment remission of primary anxiety diagnoses (CBT: 49.4%, waitlist/no treatment: 17.8%; OR 5.45, 95% confidence interval (CI) 3.90 to 7.60; n = 2697, 39 studies, moderate quality); NNTB 3 (95% CI 2.25 to 3.57) and all anxiety diagnoses (OR 4.43, 95% CI 2.89 to 6.78; n = 2075, 28 studies, moderate quality). Low-quality evidence did not show a difference between CBT and TAU in post-treatment primary anxiety disorder remission (OR 3.19, 95% CI 0.90 to 11.29; n = 487, 8 studies), but did suggest CBT may increase remission from all anxiety disorders compared to TAU (OR 2.74, 95% CI 1.16 to 6.46; n = 203, 5 studies). Compared with attention control, CBT may increase post-treatment remission of primary anxiety disorders (OR 2.28, 95% CI 1.33 to 3.89; n = 822, 10 studies, low quality) and all anxiety disorders (OR 2.75, 95% CI 1.22 to 6.17; n = 378, 5 studies, low quality). There was insufficient available data to compare CBT to alternative treatments on post-treatment remission of primary anxiety disorders, and low-quality evidence showed there may be little to no difference between these groups on post-treatment remission of all anxiety disorders (OR 0.89, 95% CI 0.35 to 2.23; n = 401, 4 studies) Low-quality evidence did not show a difference for acceptability between CBT and waitlist/no treatment (OR 1.09, 95% CI 0.85 to 1.41; n=3158, 45 studies), treatment as usual (OR 1.37, 95% CI 0.73 to 2.56; n = 441, 8 studies), attention control (OR 1.00, 95% CI 0.68 to 1.49; n = 797, 12 studies) and alternative treatment (OR 1.58, 95% CI 0.61 to 4.13; n=515, 7 studies). No adverse effects were reported across all studies; however, in the small number of studies where any reference was made to adverse effects, it was not clear that these were systematically monitored. Results from the anxiety symptom outcomes, broader outcomes, longer-term outcomes and subgroup analyses are provided in the text. We did not find evidence of consistent differences in outcomes according to delivery formats (e.g. individual versus group; amount of therapist contact time) or amongst samples with and without ASD, and no studies included samples of children with intellectual impairments. AUTHORS' CONCLUSIONS CBT is probably more effective in the short-term than waiting lists/no treatment, and may be more effective than attention control. We found little to no evidence across outcomes that CBT is superior to usual care or alternative treatments, but our confidence in these findings are limited due to concerns about the amount and quality of available evidence, and we still know little about how best to efficiently improve outcomes.
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Affiliation(s)
- Anthony C James
- Department of Psychiatry, University of Oxford, Oxford, UK
- Highfield Unit, Warneford Hospital, Oxford, UK
| | - Tessa Reardon
- Department of Psychiatry, University of Oxford, Oxford, UK
- Department of Experimental Psychology, University of Oxford, Oxford, UK
- School of Psychology & Clinical Language Sciences, University of Reading, Reading, UK
| | | | | | - Cathy Creswell
- Department of Psychiatry, University of Oxford, Oxford, UK
- Department of Experimental Psychology, University of Oxford, Oxford, UK
- School of Psychology & Clinical Language Sciences, University of Reading, Reading, UK
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16
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Gee B, Reynolds S, Carroll B, Orchard F, Clarke T, Martin D, Wilson J, Pass L. Practitioner Review: Effectiveness of indicated school-based interventions for adolescent depression and anxiety - a meta-analytic review. J Child Psychol Psychiatry 2020; 61:739-756. [PMID: 32250447 DOI: 10.1111/jcpp.13209] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/03/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Interest in delivering psychological interventions within schools to facilitate early intervention is increasing. However, most reviews have focused on universal or preventative programmes rather than interventions designed to decrease existing symptoms of depression or anxiety. This paper aims to provide a meta-analytic review of randomised controlled trials of indicated psychological interventions for young people aged 10-19 with elevated symptoms of depression and/or anxiety. METHODS Eight electronic databases were systematically searched from inception to April 2019 for eligible trials. Study quality was assessed using two scales designed to evaluate psychotherapy intervention trials. Random effects meta-analyses were conducted separately for trials that recruited participants based on symptoms of depression and based on symptoms of anxiety. RESULTS Data from 45 trials were analysed. Most interventions studied used cognitive and behavioural strategies. Few studies met methodological quality criteria, but effect size was not associated with study quality. Indicated school-based interventions had a small effect on reducing depression symptoms (SMD = .34, 95% CI -0.48, -0.21) and a medium effect on reducing anxiety symptoms (SMD = -.49, 95% CI -0.79, -0.19) immediately postintervention. Subgroup analyses indicated that interventions delivered by internal school staff did not have significant effects on symptoms. Reductions in depression were maintained at short-term (≤6 months) but not medium (>6 months ≤ 12) or long-term (>12-month) follow-up. Reductions in anxiety symptoms were not maintained at any follow-up. CONCLUSIONS Indicated school-based interventions are effective at reducing symptoms of depression and anxiety in adolescents immediately postintervention but there is little evidence that these reductions are maintained. Interventions delivered by school staff are not supported by the current evidence base. Further high-quality randomised controlled trials incorporating assessment of longer-term outcomes are needed to justify increased investment in school-based interventions for adolescent depression and anxiety.
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Affiliation(s)
- Brioney Gee
- Research & Development Department, Norfolk and Suffolk NHS Foundation Trust, Norwich, UK.,Norwich Medical School, University of East Anglia, Norwich, UK
| | - Shirley Reynolds
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Ben Carroll
- Research & Development Department, Norfolk and Suffolk NHS Foundation Trust, Norwich, UK
| | - Faith Orchard
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Tim Clarke
- Research & Development Department, Norfolk and Suffolk NHS Foundation Trust, Norwich, UK.,Norwich Medical School, University of East Anglia, Norwich, UK
| | - David Martin
- Research & Development Department, Norfolk and Suffolk NHS Foundation Trust, Norwich, UK
| | - Jon Wilson
- Research & Development Department, Norfolk and Suffolk NHS Foundation Trust, Norwich, UK.,Norwich Medical School, University of East Anglia, Norwich, UK
| | - Laura Pass
- Norwich Medical School, University of East Anglia, Norwich, UK.,School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
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17
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Stoll RD, Pina AA, Schleider J. Brief, Non-Pharmacological, Interventions for Pediatric Anxiety: Meta-Analysis and Evidence Base Status. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2020; 49:435-459. [PMID: 32285692 PMCID: PMC7473445 DOI: 10.1080/15374416.2020.1738237] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
In 1998, Ost published [One-session treatment of specific phobias-a rapid and effective method] [in Swedish] giving rise to the idea that brief, intensive, and concentrated psychosocial interventions could exhibit public health impact. At this juncture, and per criteria of the Society for Clinical Child and Adolescent Psychology, there are data supporting that brief, non-pharmacological intervention [prescriptions] for pediatric anxiety can be considered well-established or probably efficacious. In addition, data from 76 randomized controlled trials (N = 17,203 youth) yield an overall mean effect size of 0.19 on pediatric anxiety outcomes (pre-post). Note, however, that effect sizes vary significantly. These data point to the capacity for clinical change coming from in-vivo exposures for specific phobias (~3 h, one session), CBT with social skills training (~3 h, six sessions for indicated prevention and early intervention), and CBT-based parent training (~6 h, eight digital modules with clinician support). Given such evidence, we recommend efforts be made to establish ways to position such treatment innovations for rapid deployment facilitated by high-quality training, monitoring, technical assistance, and ongoing disclosures.
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Affiliation(s)
- Ryan D Stoll
- Department of Psychology, Arizona State University
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18
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Caron EB, Drake KL, Stewart CE, Muggeo MA, Ginsburg GS. Intervention Adherence and Self-Efficacy as Predictors of Child Outcomes in School Nurse-Delivered Interventions for Anxiety. J Sch Nurs 2020; 38:249-258. [PMID: 32410495 DOI: 10.1177/1059840520925522] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This study examined the association between two implementation factors, nurse-reported intervention adherence and self-efficacy, and children's outcomes in school nurse-delivered anxiety interventions. Data were collected in a pilot randomized controlled effectiveness trial with 54 children and 21 school nurses. Nurses implemented either a cognitive behavioral or relaxation-skills-only intervention. Nurse questionnaires assessed implementation factors. Independent evaluators assessed changes in children's anxiety symptoms at postintervention and at 3-month follow-up using clinical improvement and global functioning scales. Regression analyses indicated that greater intervention adherence was associated with greater anxiety symptom improvement at follow-up. Nurse self-efficacy interacted with intervention group, such that nurses with higher self-efficacy who implemented the cognitive behavioral intervention tended to have children show improvement and higher postintervention functioning. The impact of implementation factors on children's outcomes may differ depending on intervention type. Self-efficacy may be important for nurses using relatively complex interventions. Intervention adherence should be supported through training and consultation.
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Affiliation(s)
- E B Caron
- Department of Psychological Science, Fitchburg State University, MA, USA
| | - Kelly L Drake
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD, USA.,Anxiety Treatment Center of Maryland, Columbia, MD, USA
| | - Catherine E Stewart
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, USA
| | | | - Golda S Ginsburg
- Department of Psychiatry, University of Connecticut School of Medicine, West Hartford, CT, USA
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19
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Sigurvinsdóttir AL, Jensínudóttir KB, Baldvinsdóttir KD, Smárason O, Skarphedinsson G. Effectiveness of cognitive behavioral therapy (CBT) for child and adolescent anxiety disorders across different CBT modalities and comparisons: a systematic review and meta-analysis. Nord J Psychiatry 2020; 74:168-180. [PMID: 31738631 DOI: 10.1080/08039488.2019.1686653] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Aim: Pediatric Anxiety Disorders (AD) are common. Cognitive behavioral therapy (CBT) is one of two first-line treatments of youth AD and it has previously been shown to be superior to wait-list but not placebo therapy. This study consists of a systematic review and meta-analysis of the literature to assess the efficacy of CBT modalities in comparison to control contingencies for pediatric anxiety disorders.Methods: Studies were included if they were randomized controlled trials, and if CBT was manualized or modular, alone or in combination with medication. CBT was required to include behavioral treatment, exposure treatment, or cognitive elements. Eligible studies included participants aged 18 years or younger.Results: Eighty-one studies were included, with 3386 CBT participants and 2527 control participants. The overall results indicated that CBT is an effective treatment for childhood AD. The results showed that individual-based CBT is superior to wait-list and attention control. Group-based CBT is superior to wait-list control and treatment as usual. Remote-based CBT was superior to attention control and wait-list control. Family-based CBT was superior to treatment as usual, wait-list control, and attention control. Selective serotonin reuptake inhibitors were no more effective than individual-based CBT. Combination treatment was, however, more effective than individual-based CBT.Conclusion: To the best of our knowledge, no meta-analysis has thus far disentangled the effects of CBT modalities across various comparisons. This meta-analysis hence provides an important update to the literature on the efficacy of CBT for treating anxiety disorders in young people.
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Affiliation(s)
| | | | | | - Orri Smárason
- Faculty of Psychology, University of Iceland, Reykjavik, Iceland.,Landspitali - the National University Hospital of Iceland, Reykjavik, Iceland
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20
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Collyer H, Eisler I, Woolgar M. Systematic literature review and meta-analysis of the relationship between adherence, competence and outcome in psychotherapy for children and adolescents. Eur Child Adolesc Psychiatry 2020; 29:417-431. [PMID: 30604132 PMCID: PMC7103576 DOI: 10.1007/s00787-018-1265-2] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Accepted: 12/05/2018] [Indexed: 11/29/2022]
Abstract
The extent to which therapist adherence to guidelines and clinician skill or competence may play a role in the prediction of therapeutic outcomes remains inconclusive. This systematic literature review and meta-analysis considers whether adherence or competence predicts youth outcome in child and adolescent psychotherapy, and whether there are any identifiable factors which moderate the strength or direction of this relationship. A systematic literature search identified 35 studies in 52 papers. The studies contained 29 effect sizes for the relationship between adherence and outcome, while nine effect sizes were extracted for competence, and a further five effects measured a composite of adherence and competence constructs, referred to as fidelity in this report. The meta-analysis indicated a small but significant relationship between therapist adherence and outcome, although the small size of effect suggests that outcomes are likely to be more strongly associated with factors other than adherence. No significant relationship was identified between competence or composite fidelity and outcome. Although variance was observed in effect sizes, no significant moderation by client group, intervention type, or implementation measure informant was identified. Further study is needed to understand the specific circumstances under which adherence and outcome are related.
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Affiliation(s)
- Hannah Collyer
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| | - Ivan Eisler
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Matt Woolgar
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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21
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Ginsburg GS, Pella JE, Pikulski PJ, Tein JY, Drake KL. School-Based Treatment for Anxiety Research Study (STARS): a Randomized Controlled Effectiveness Trial. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2020; 48:407-417. [PMID: 31749064 DOI: 10.1007/s10802-019-00596-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The current study compared the effectiveness of a school-clinician administered cognitive behavioral treatment (CBT) to treatment as usual (TAU) at post-treatment (i.e., after 12 weeks) and at a 1 year follow-up. Sixty-two school-based clinicians (37 in CBT; 25 in TAU) and 216 students (148 students in CBT; 68 in TAU) participated. Students were ages 6-18 (mean age 10.87; 64% Caucasian & 29% African American; 48.6% female) and all met DSM-IV diagnostic criteria for a primary anxiety disorder. Independent evaluators (IEs) assessed clinical improvement, global functioning, and loss of anxiety diagnoses; children and parents completed measures of anxiety symptoms. At post-treatment, no significant treatment main effects emerged on the primary outcome; 42% and 37% of youth were classified as treatment responders in CBT and TAU respectively. However, parent-report of child anxiety showed greater improvements in CBT relative to TAU (d = .29). Moderation analyses at post-treatment indicated that older youth, those with social phobia and more severe anxiety at baseline were more likely to be treatment responders in CBT compared to TAU. At the 1 year follow-up, treatment gains were maintained but no treatment group differences or moderators emerged. CBT and TAU for pediatric anxiety disorders, when delivered by school clinicians were generally similar in effectiveness for lowering anxiety and improving functioning at both post-treatment (on all but the parent measure and for specific subgroups) and 1 year follow-up. Implications for disseminating CBT in the school setting are discussed.
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Affiliation(s)
- Golda S Ginsburg
- Department of Psychiatry, University of Connecticut School of Medicine, 65 Kane Street Room 2033, West Hartford, CT, 06119, USA.
| | - Jeffrey E Pella
- Department of Psychiatry, University of Connecticut School of Medicine, 65 Kane Street Room 2033, West Hartford, CT, 06119, USA
| | - Paige J Pikulski
- Department of Psychiatry, University of Connecticut School of Medicine, 65 Kane Street Room 2033, West Hartford, CT, 06119, USA
| | | | - Kelly L Drake
- Anxiety Treatment Center of Maryland, The Johns Hopkins Unviersity School of Medicine Baltimore, Baltimore, MD, 21205, USA
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22
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Husabo E, Haugland BSM, McLeod BD, Ogden T, Rapee RM, Wergeland GJ. Does School-Based Recruitment for Anxiety Interventions Reach Youth Not Otherwise Identified? A Comparison Between a School-Based Sample and a Clinical Sample. SCHOOL MENTAL HEALTH 2020. [DOI: 10.1007/s12310-019-09357-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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23
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Ginsburg GS, Pella JE, Piselli K, Chan G. Teacher Anxiety Program for Elementary Students (TAPES): intervention development and proposed randomized controlled trial. Trials 2019; 20:792. [PMID: 31888726 PMCID: PMC6937798 DOI: 10.1186/s13063-019-3863-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Accepted: 10/29/2019] [Indexed: 11/10/2022] Open
Abstract
Background Excessive student anxiety is a common problem that severely impairs short- and long-term academic functioning and increases teacher burden. Reducing student anxiety has been associated with improvement in educational functioning. Because anxiety manifests daily in the classroom, teachers are in an ideal position to identify and help students manage their anxiety. Unfortunately, teachers lack the knowledge and skills to support the learning of students with excessive anxiety. The Teacher Anxiety Program for Elementary Students (TAPES), a novel teacher-administered school-home collaborative intervention, was designed to address this gap. Methods This manuscript describes the protocol for developing and evaluating TAPES. Specifically, we present a description of: (1) the intervention and theoretical model; and (2) methods for the proposed randomized controlled trial comparing TAPES to a standard professional development seminar focused on reducing student anxiety. Discussion Primary aims examine the impact of the TAPES training on teacher knowledge and skill. Secondary aims examine the impact of TAPES on student outcomes. Exploratory aims will examine mediators based on our proposed theory of change. If effective, TAPES has the potential to directly benefit teachers (improving skills) and students (reducing anxiety and improving functioning). Trial registration ClinicalTrials.gov, NCT03899948. Registered on 28 March 2019.
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Affiliation(s)
- Golda S Ginsburg
- University of Connecticut School of Medicine, 65 Kane Street Room 2033, West Hartford, CT, 06119, USA.
| | - Jeffrey E Pella
- University of Connecticut School of Medicine, 65 Kane Street Room 2033, West Hartford, CT, 06119, USA
| | - Kate Piselli
- University of Connecticut School of Medicine, 65 Kane Street Room 2033, West Hartford, CT, 06119, USA
| | - Grace Chan
- University of Connecticut School of Medicine, 65 Kane Street Room 2033, West Hartford, CT, 06119, USA.,University of Connecticut School of Medicine Department of Psychiatry, 263 Farmington Avenue, Farmington, CT, 06030-2103, USA
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24
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Concordance between clinician, supervisor and observer ratings of therapeutic competence in CBT and treatment as usual: does clinician competence or supervisor session observation improve agreement? Behav Cogn Psychother 2019; 48:350-363. [PMID: 31806076 DOI: 10.1017/s1352465819000699] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Lowering the cost of assessing clinicians' competence could promote the scalability of evidence-based treatments such as cognitive behavioral therapy (CBT). AIMS This study examined the concordance between clinicians', supervisors' and independent observers' session-specific ratings of clinician competence in school-based CBT and treatment as usual (TAU). It also investigated the association between clinician competence and supervisory session observation and rater agreement. METHOD Fifty-nine school-based clinicians (90% female, 73% Caucasian) were randomly assigned to implement TAU or modular CBT for youth anxiety. Clinicians rated their confidence after each therapy session (n = 1898), and supervisors rated clinicians' competence after each supervision session (n = 613). Independent observers rated clinicians' competence from audio recordings (n = 395). RESULTS Patterns of rater discrepancies differed between the TAU and CBT groups. Correlations with independent raters were low across groups. Clinician competence and session observation were associated with higher agreement among TAU, but not CBT, supervisors and clinicians. CONCLUSIONS These results support the gold standard practice of obtaining independent ratings of adherence and competence in implementation contexts. Further development of measures and/or rater training methods for clinicians and supervisors is needed.
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25
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Sanchez AL, Comer JS, Coxe S, Albano AM, Piacentini J, Compton SN, Ginsburg GS, Rynn MA, Walkup JT, Sakolsky DJ, Birmaher B, Kendall PC. The Effects of Youth Anxiety Treatment on School Impairment: Differential Outcomes Across CBT, Sertraline, and their Combination. Child Psychiatry Hum Dev 2019; 50:940-949. [PMID: 31087216 DOI: 10.1007/s10578-019-00896-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Youth anxiety disorders are highly prevalent and are associated with considerable school impairment. Despite the identification of well-supported strategies for treating youth anxiety, research has yet to evaluate the differential effects of these treatments on anxiety-related school impairment. The present study leveraged data from the Child/Adolescent Anxiety Multimodal Study to examine differential treatment effects of CBT, sertraline, and their combination (COMB), relative to placebo (PBO), on anxiety-related school impairment among youth (N = 488). Latent growth modeling revealed that all three active treatments demonstrated superiority over PBO in reducing anxiety-related school impairment over time, with COMB showing the most robust effects. According to parent report, medication strategies may have stronger effects on anxiety-related school impairment among males than among females. Results were discrepant across parents and youth. Findings are discussed in terms of clinical implications for anxious youth and the need for continued research to examine treatment effects on anxiety-related school impairment.
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Affiliation(s)
- Amanda L Sanchez
- Center for Children and Families and Department of Psychology, Florida International University, Miami, FL, USA.
| | - Jonathan S Comer
- Center for Children and Families and Department of Psychology, Florida International University, Miami, FL, USA
| | - Stefany Coxe
- Center for Children and Families and Department of Psychology, Florida International University, Miami, FL, USA
| | - Anne Marie Albano
- Division of Child & Adolescent Psychiatry, Department of Psychiatry, Columbia University Medical Center, New York State Psychiatric Institute, New York, NY, USA
| | - John Piacentini
- Department of Psychiatry and Biobehavioral Sciences, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA
| | - Scott N Compton
- Department of Psychiatry and Biobehavioral Sciences, Duke University, Durham, NC, USA
| | - Golda S Ginsburg
- Department of Psychiatry, University of Connecticut School of Medicine, Farmington, CT, USA
| | - Moira A Rynn
- Department of Psychiatry and Biobehavioral Sciences, Duke University, Durham, NC, USA
| | - John T Walkup
- Anne and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Dara J Sakolsky
- Western Psychiatric Institute and Clinic-University of Pittsburgh Medical Center, Pittsburgh, USA
| | - Boris Birmaher
- Western Psychiatric Institute and Clinic-University of Pittsburgh Medical Center, Pittsburgh, USA
| | - Philip C Kendall
- Department of Psychology, Temple University, Philadelphia, PA, USA
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26
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Addressing the Needs of Diverse Youth with ASD and Anxiety in Public Schools: Stakeholder Input on Adaptations of Clinic-Based Facing Your Fears. SCHOOL MENTAL HEALTH 2019. [DOI: 10.1007/s12310-019-09351-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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27
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Rapley HA, Loades ME. A systematic review exploring therapist competence, adherence, and therapy outcomes in individual CBT for children and young people. Psychother Res 2019; 29:1010-1019. [PMID: 29683046 PMCID: PMC6763333 DOI: 10.1080/10503307.2018.1464681] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 03/21/2018] [Accepted: 04/03/2018] [Indexed: 10/17/2022] Open
Abstract
Objective: Whilst the evidence base for cognitive behavioural therapy (CBT) with children and young people is growing, the mechanisms through which these beneficial effects occur are still unclear. This systematic review seeks to appraise the relationship between therapeutic outcomes in CBT and therapist adherence and competence, within the child and adolescent literature. Method: A systematic review was carried out, with five studies identified as meeting the inclusion criteria. Results: The literature is currently small and inconclusive. Amongst the studies reviewed, there were inconsistent findings, with minimal-to-no effect sizes found between adherence, competence, and outcomes. Conclusions: The current paucity of research in this area means that conclusions are currently limited. The role and impact of adherence and competence on therapeutic outcomes remains unclear within individual CBT in a child population. This is comparable with the current adult literature, where findings also remain inconclusive. Further research avenues are discussed.
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Affiliation(s)
- Hannah A Rapley
- Department of Psychology, University of Bath , Bath , UK
- Oxford Health NHS Foundation Trust , Oxford , UK
| | - Maria E Loades
- Department of Psychology, University of Bath , Bath , UK
- Bristol Medical School, University of Bristol , Bristol , UK
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Ginsburg GS, Drake KL, Muggeo MA, Stewart CE, Pikulski PJ, Zheng D, Harel O. A pilot RCT of a school nurse delivered intervention to reduce student anxiety. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2019; 50:177-186. [PMID: 31373524 DOI: 10.1080/15374416.2019.1630833] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The goal of this study was to evaluate the feasibility and impact of brief school-nurse-administered interventions for reducing anxiety. Thirty school nurses in Connecticut and Maryland were randomly assigned to deliver the Child Anxiety Learning Modules (CALM; n = 14) or CALM-Relaxation only (CALM-R; n = 16). Students (N = 54) were ages 5-12 (M age = 8; 84.9% White; 68.5% female) with elevated anxiety symptoms and/or anxiety disorders. Feasibility was assessed based on recruitment, retention, attendance, training and intervention satisfaction, and intervention adherence. Multiple informants, including independent evaluators (IEs), completed measures of clinical improvement at postintervention and at a 3-month follow-up. Of nurses in CALM and CALM-R, 62% and 81%, respectively, enrolled a student and completed an average of 6 sessions. Youth retention was 85% and 94% in CALM and CALM-R, respectively. Training and intervention satisfaction were high. At postintervention and follow-up, youth in both groups showed significant reductions in anxiety and related symptoms and improvements in functioning. Within-group effect sizes were medium to large, and between-group effect sizes were small. Task shifting responsibility for delivering brief mental health interventions to school nurses is feasible and shows promise for reducing anxiety and related impairment. This approach may also be integrated within a response to intervention model used in schools.Public Health Significance: Brief school-nurse-administered anxiety reduction interventions were shown to be feasible and had a positive impact on student anxiety and related impairment highlighting that school nurses can be an important school resource.
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Affiliation(s)
- Golda S Ginsburg
- Department of Psychiatry, University of Connecticut School of Medicine
| | - Kelly L Drake
- The Johns Hopkins University School of Medicine, c/o Anxiety Treatment Center of Maryland
| | - Michela A Muggeo
- Department of Psychiatry, University of Connecticut School of Medicine
| | | | - Paige J Pikulski
- Department of Psychiatry, University of Connecticut School of Medicine
| | - Di Zheng
- Department of Statistics, University of Connecticut
| | - Ofer Harel
- Department of Statistics, University of Connecticut
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Exploring Treatment as Usual for Pediatric Anxiety Disorders Among School-Based Clinicians. SCHOOL MENTAL HEALTH 2019. [DOI: 10.1007/s12310-019-09331-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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30
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The Factor Structure of the Cognitive Therapy Rating Scale (CTRS) in a Sample of Community Mental Health Clinicians. COGNITIVE THERAPY AND RESEARCH 2019. [DOI: 10.1007/s10608-019-09998-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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31
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Jensen-Doss A, Ehrenreich-May J, Nanda MM, Maxwell CA, LoCurto J, Shaw AM, Souer H, Rosenfield D, Ginsburg GS. Community Study of Outcome Monitoring for Emotional Disorders in Teens (COMET): A comparative effectiveness trial of a transdiagnostic treatment and a measurement feedback system. Contemp Clin Trials 2018; 74:18-24. [PMID: 30282056 PMCID: PMC6249684 DOI: 10.1016/j.cct.2018.09.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 09/27/2018] [Accepted: 09/28/2018] [Indexed: 11/29/2022]
Abstract
Emotional disorders, encompassing a range of anxiety and depressive disorders, are the most prevalent and comorbid psychiatric disorders in adolescence. Unfortunately, evidence-based psychosocial therapies typically focus on single disorders, are rarely adopted by community mental health center clinicians, and effect sizes are modest. This article describes the protocol for a comparative effectiveness study of two novel interventions designed to address these challenges. The first intervention is a transdiagnostic treatment (the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Adolescents, UP-A), a promising new approach that uses a small number of common strategies to treat a broad range of emotional disorders, and their underlying shared emotional vulnerabilities. The second intervention is a standardized measurement feedback system, the Youth Outcomes Questionnaire (YOQ), designed to improve clinical decision making using weekly symptom and relational data. The three study arms are treatment as usual (TAU), TAU plus the YOQ (TAU+), and UP-A (used in combination with the YOQ). The primary aims of the study are to [1] compare the effects of the UP-A and TAU+ to TAU in community mental health clinics, [2] to isolate the effects of measurement and feedback by comparing the UP-A and TAU+ condition, and [3] to examine the mechanisms of action of both interventions. Design considerations and study methods are provided to inform future effectiveness research.
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Affiliation(s)
- Amanda Jensen-Doss
- University of Miami, Department of Psychology, P.O. Box 248185, Coral Gables, FL 33124-0751, USA.
| | - Jill Ehrenreich-May
- University of Miami, Department of Psychology, P.O. Box 248185, Coral Gables, FL 33124-0751, USA
| | - Monica M Nanda
- University of Miami, Department of Psychology, P.O. Box 248185, Coral Gables, FL 33124-0751, USA
| | - Colleen A Maxwell
- University of Miami, Department of Psychology, P.O. Box 248185, Coral Gables, FL 33124-0751, USA
| | - Jamie LoCurto
- University of Connecticut School of Medicine, 65 Kane Street Room 3022, West Hartford, CT 06119, USA
| | - Ashley M Shaw
- University of Miami, Department of Psychology, P.O. Box 248185, Coral Gables, FL 33124-0751, USA
| | - Heather Souer
- University of Connecticut School of Medicine, 65 Kane Street Room 3022, West Hartford, CT 06119, USA
| | - David Rosenfield
- Southern Methodist University, Department of Psychology, P.O. Box 750442, Dallas, TX 75275, USA
| | - Golda S Ginsburg
- University of Connecticut School of Medicine, 65 Kane Street Room 3022, West Hartford, CT 06119, USA
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Kilbourne AM, Smith SN, Choi SY, Koschmann E, Liebrecht C, Rusch A, Abelson JL, Eisenberg D, Himle JA, Fitzgerald K, Almirall D. Adaptive School-based Implementation of CBT (ASIC): clustered-SMART for building an optimized adaptive implementation intervention to improve uptake of mental health interventions in schools. Implement Sci 2018; 13:119. [PMID: 30185192 PMCID: PMC6126013 DOI: 10.1186/s13012-018-0808-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 08/15/2018] [Indexed: 12/13/2022] Open
Abstract
Background Depressive and anxiety disorders affect 20–30% of school-age youth, most of whom do not receive adequate services, contributing to poor developmental and academic outcomes. Evidence-based practices (EBPs) such as cognitive behavioral therapy (CBT) can improve outcomes, but numerous barriers limit access among affected youth. Many youth try to access mental health services in schools, but school professionals (SPs: counselors, psychologists, social workers) are rarely trained adequately in CBT methods. Further, SPs face organizational barriers to providing CBT, such as lack of administrative support. Three promising implementation strategies to address barriers to school-based CBT delivery include (1) Replicating Effective Programs (REP), which deploys customized CBT packaging, didactic training in CBT, and technical assistance; (2) coaching, which extends training via live supervision to improve SP competence in CBT delivery; and (3) facilitation, which employs an organizational expert who mentors SPs in strategic thinking to promote self-efficacy in garnering administrative support. REP is a relatively low-intensity/low-cost strategy, whereas coaching and facilitation require additional resources. However, not all schools will require all three strategies. The primary aim of this study is to compare the effectiveness of a school-level adaptive implementation intervention involving REP, coaching, and facilitation versus REP alone on the frequency of CBT delivered to students by SPs and student mental health outcomes. Secondary and exploratory aims examine cost-effectiveness, moderators, and mechanisms of implementation strategies. Methods Using a clustered, sequential multiple-assignment, randomized trial (SMART) design, ≥ 200 SPs from 100 schools across Michigan will be randomized initially to receive REP vs. REP+coaching. After 8 weeks, schools that do not meet a pre-specified implementation benchmark are re-randomized to continue with the initial strategy or to augment with facilitation. Discussion EBPs need to be implemented successfully and efficiently in settings where individuals are most likely to seek care in order to gain large-scale impact on public health. Adaptive implementation interventions hold the promise of providing cost-effective implementation support. This is the first study to test an adaptive implementation of CBT for school-age youth, at a statewide level, delivered by school staff, taking an EBP to large populations with limited mental health care access. Trial registration NCT03541317—Registered on 29 May 2018 on ClinicalTrials.gov PRS Electronic supplementary material The online version of this article (10.1186/s13012-018-0808-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Amy M Kilbourne
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA. .,U.S. Department of Veterans Affairs, Quality Enhancement Research Initiative, Washington D.C., USA.
| | - Shawna N Smith
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Seo Youn Choi
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Elizabeth Koschmann
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Celeste Liebrecht
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Amy Rusch
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
| | - James L Abelson
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Daniel Eisenberg
- School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Joseph A Himle
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA.,School of Social Work, University of Michigan, Ann Arbor, MI, USA
| | - Kate Fitzgerald
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Daniel Almirall
- Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
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Abstract
PURPOSE OF REVIEW We review recent research validating cognitive behavioral therapy (CBT) as a first-line intervention for childhood anxiety disorders. We also review recent research aimed at enhancing exposure-based CBT components and adapting CBT to work with specific populations. RECENT FINDINGS Exposure-based CBT is a well-established intervention. Different research groups have found positive evidence to augment CBT by evaluating inhibitory learning principles, the role of parents in child treatment, an individualized case formulation, computer and online forms of CBT, and virtual and augmented reality systems for exposure practice. Specific programs have been developed to meet specific needs of preschoolers, adolescents, and children with comorbid autism spectrum disorder and anxiety. Successful adaptations to CBT exist and the field should continue to improve the generalizability, feasibility, and expected benefit of CBT to improve its effectiveness.
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34
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The Feasibility and Effectiveness of School-Based Modular Therapy: A Systematic Literature Review. SCHOOL MENTAL HEALTH 2018. [DOI: 10.1007/s12310-018-9270-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Laakmann M, Petermann U, Petermann F. Elternarbeit im Kontext der Angstbehandlung von Kindern. KINDHEIT UND ENTWICKLUNG 2017. [DOI: 10.1026/0942-5403/a000219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Zusammenfassung. Angststörungen sind im Kindes- und Jugendalter weit verbreitet. Die kognitive Verhaltenstherapie (CBT) hat sich als Intervention der Wahl erwiesen. Neben Psychoedukation, kognitiven Techniken und Expositionsübungen ist auch die therapeutische Arbeit mit den Eltern eine häufig eingesetzte Methode. In der vorliegenden Übersichtsarbeit wird der Frage nachgegangen, ob der Einsatz von Elternarbeit in der Therapie mit ängstlichen Kindern die Effektivität der Intervention steigert. Im Rahmen eines systematischen Reviews wurden 25 Studien identifiziert, die von wenigen Elternsitzungen bis hin zu reinen Elterntrainings ein großes Spektrum der Elternarbeit bei Kindern mit einer Angststörung abdecken. Es zeigt sich, dass die CBT Wartekontrollgruppen hinsichtlich der Remissionsrate der Angststörungen generell überlegen ist. Behandlungsansätze, die neben der kindbezogenen Intervention ein Elterntraining enthalten, erweisen sich nicht wirksamer im Vergleich zu ausschließlich kindbezogenen Interventionen. Mögliche Erklärungen für das Ausbleiben der Wirksamkeitssteigerung und daraus resultierende Konsequenzen werden diskutiert.
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Affiliation(s)
- Mirjam Laakmann
- Zentrum für Klinische Psychologie und Rehabilitation der Universität Bremen
| | - Ulrike Petermann
- Zentrum für Klinische Psychologie und Rehabilitation der Universität Bremen
| | - Franz Petermann
- Zentrum für Klinische Psychologie und Rehabilitation der Universität Bremen
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Freidl EK, Stroeh OM, Elkins RM, Steinberg E, Albano AM, Rynn M. Assessment and Treatment of Anxiety Among Children and Adolescents. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2017; 15:144-156. [PMID: 31975847 PMCID: PMC6526964 DOI: 10.1176/appi.focus.20160047] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Among children and adolescents, anxiety disorders are common psychiatric disorders that confer risk of comorbid psychiatric disorders and social and academic impairment. This review focuses on the assessment and treatment of anxiety disorders among children and adolescents, with attention to separation anxiety disorder, social phobia disorder (social anxiety disorder), panic disorder, and generalized anxiety disorder. Comprehensive assessment of child and adolescent anxiety disorders benefits from a multimethod approach to evaluation and diagnosis, including semistructured interviews; child and informant questionnaires; collateral information from parents, teachers, pediatricians, and school psychologists; and behavioral observations. Because anxiety symptoms can include avoidance behaviors, somatic complaints, social difficulties, and sleep disturbances, consideration of a differential diagnosis is important. Among the available psychosocial interventions, cognitive-behavioral therapy (CBT) and exposure-based therapies have emerged as the most well-established treatment approaches for addressing anxiety disorders among children and adolescents. Pharmacologically, selective serotonin reuptake inhibitors (SSRIs) have been established to be safe and efficacious for the treatment of pediatric anxiety and are considered the medications of choice for this population. Research indicates that CBT plus SSRI medication is the most effective treatment of anxiety for youths ages seven to 17, compared with either CBT or medication alone. Medication monotherapy and CBT monotherapy have also been demonstrated to be effective treatments.
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Affiliation(s)
- Eve Khlyavich Freidl
- Dr. Freidl, Dr. Stroeh, Dr. Albano, and Dr. Rynn are with the Department of Psychiatry and Ms. Steinberg is with the Cognitive Development and Neuroimaging Lab, all at Columbia University Medical Center and New York State Psychiatric Institute, New York City. Dr. Freidl, Dr. Albano, and Dr. Rynn are also with the Columbia University Clinic for Anxiety and Related Disorders, where Dr. Elkins is a postdoctoral fellow
| | - Oliver M Stroeh
- Dr. Freidl, Dr. Stroeh, Dr. Albano, and Dr. Rynn are with the Department of Psychiatry and Ms. Steinberg is with the Cognitive Development and Neuroimaging Lab, all at Columbia University Medical Center and New York State Psychiatric Institute, New York City. Dr. Freidl, Dr. Albano, and Dr. Rynn are also with the Columbia University Clinic for Anxiety and Related Disorders, where Dr. Elkins is a postdoctoral fellow
| | - R Meredith Elkins
- Dr. Freidl, Dr. Stroeh, Dr. Albano, and Dr. Rynn are with the Department of Psychiatry and Ms. Steinberg is with the Cognitive Development and Neuroimaging Lab, all at Columbia University Medical Center and New York State Psychiatric Institute, New York City. Dr. Freidl, Dr. Albano, and Dr. Rynn are also with the Columbia University Clinic for Anxiety and Related Disorders, where Dr. Elkins is a postdoctoral fellow
| | - Emily Steinberg
- Dr. Freidl, Dr. Stroeh, Dr. Albano, and Dr. Rynn are with the Department of Psychiatry and Ms. Steinberg is with the Cognitive Development and Neuroimaging Lab, all at Columbia University Medical Center and New York State Psychiatric Institute, New York City. Dr. Freidl, Dr. Albano, and Dr. Rynn are also with the Columbia University Clinic for Anxiety and Related Disorders, where Dr. Elkins is a postdoctoral fellow
| | - Anne Marie Albano
- Dr. Freidl, Dr. Stroeh, Dr. Albano, and Dr. Rynn are with the Department of Psychiatry and Ms. Steinberg is with the Cognitive Development and Neuroimaging Lab, all at Columbia University Medical Center and New York State Psychiatric Institute, New York City. Dr. Freidl, Dr. Albano, and Dr. Rynn are also with the Columbia University Clinic for Anxiety and Related Disorders, where Dr. Elkins is a postdoctoral fellow
| | - Moira Rynn
- Dr. Freidl, Dr. Stroeh, Dr. Albano, and Dr. Rynn are with the Department of Psychiatry and Ms. Steinberg is with the Cognitive Development and Neuroimaging Lab, all at Columbia University Medical Center and New York State Psychiatric Institute, New York City. Dr. Freidl, Dr. Albano, and Dr. Rynn are also with the Columbia University Clinic for Anxiety and Related Disorders, where Dr. Elkins is a postdoctoral fellow
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Oar EL, McLellan LF, Rapee RM. Adapting Cognitive Behavioral Therapy for Anxious Children and Adolescents. J Cogn Psychother 2017; 31:23-40. [PMID: 32755916 DOI: 10.1891/0889-8391.31.1.23] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This article discusses considerations for adapting cognitive behavioral therapy (CBT) techniques and processes with anxious children and adolescents. To successfully deliver CBT with this population, the therapist must take into consideration the child's developmental level and other contextual factors that may affect treatment outcome. Suggested adaptions to CBT include the use of rewards, technology, and interactive activities to increase child motivation and engagement. Moreover, dependent on the child's or adolescent's cognitive capacity, cognitive techniques will need to be simplified and concrete examples provided to increase children's understanding. It may be beneficial to have parents and/or schools involved in children's treatment to assist them to implement CBT strategies outside of the therapy setting. A case example is presented to illustrate the implementation of CBT with a child.
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Affiliation(s)
- Ella L Oar
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia
| | - Lauren F McLellan
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia
| | - Ronald M Rapee
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia
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Ale CM, McCarthy DM, Rothschild LM, Whiteside SPH. Components of Cognitive Behavioral Therapy Related to Outcome in Childhood Anxiety Disorders. Clin Child Fam Psychol Rev 2016; 18:240-51. [PMID: 26001645 DOI: 10.1007/s10567-015-0184-8] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The present article uses meta-analysis to examine treatment components related to outcome within 35 randomized controlled trials (RCTs) for childhood anxiety disorders (CADs) and eight RCTs for childhood obsessive compulsive disorder (OCD). Examination of the RCTs of cognitive behavioral therapy (CBT) for CADs suggested that adding relaxation and delaying exposures until after the introduction of other anxiety management strategies does not increase the efficacy of exposure-based treatment. In addition, compared to the large effect size (ES) associated with exposure and response prevention (ERP) for OCD (k = 9, mean ES = 1.93), the effect size associated with CBT for CADs (k = 44, mean ES = 0.89) did not differentiate from attention placebo (k = 11, mean ES = 0.55), although it was more effective than waitlist control (k = 24, mean ES = 0.22). Instructively, ERP for OCD involved more exposure initiated earlier and less relaxation than CBT for CADs. In addition, RCTs of ERP were more likely to use clinician-administered measures as opposed to self-report and to be conducted in clinical versus recruited samples. These results suggest that dismantling studies using a gold-standard clinician-rated outcome measure to compare the value of adding anxiety management strategies to exposure will be necessary to increase the efficacy of CBT for CADs to levels achieved by ERP for OCD.
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Affiliation(s)
- Chelsea M Ale
- Department of Psychiatry and Psychology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
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Masia Warner C, Colognori D, Brice C, Herzig K, Mufson L, Lynch C, Reiss PT, Petkova E, Fox J, Moceri DC, Ryan J, Klein RG. Can school counselors deliver cognitive-behavioral treatment for social anxiety effectively? A randomized controlled trial. J Child Psychol Psychiatry 2016; 57:1229-1238. [PMID: 27002215 DOI: 10.1111/jcpp.12550] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/08/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Social anxiety disorder (SAD) typically onsets in adolescence and is associated with multiple impairments. Despite promising clinical interventions, most socially anxious adolescents remain untreated. To address this clinical neglect, we developed a school-based, 12-week group intervention for youth with SAD, Skills for Academic and Social Success (SASS). When implemented by psychologists, SASS has been found effective. To promote dissemination and optimize treatment access, we tested whether school counselors could be effective treatment providers. METHOD We randomized 138, ninth through 11th graders with SAD to one of three conditions: (a) SASS delivered by school counselors (C-SASS), (b) SASS delivered by psychologists (P-SASS), or (c) a control condition, Skills for Life (SFL), a nonspecific counseling program. Blind, independent, evaluations were conducted with parents and adolescents at baseline, post-intervention, and 5 months beyond treatment completion. We hypothesized that C-SASS and P-SASS would be superior to the control, immediately after treatment and at follow-up. No prediction was made about the relative efficacy of C-SASS and P-SASS. RESULTS Compared to controls, adolescents treated with C-SASS or P-SASS experienced significantly greater improvement and reductions of anxiety at the end of treatment and follow-up. There were no significant differences between SASS delivered by school counselors and psychologists. CONCLUSION With training, school counselors are effective treatment providers to adolescents with social anxiety, yielding benefits comparable to those obtained by specialized psychologists. Questions remain regarding means to maintain counselors' practice standards without external support.
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Affiliation(s)
- Carrie Masia Warner
- Department of Psychology, William Paterson University, Wayne, NJ, USA. .,Nathan Kline Institute for Psychiatric Research, Orangeburg, NY, USA. .,Department of Child & Adolescent Psychiatry, NYU Langone Medical Center, New York, NY, USA.
| | - Daniela Colognori
- Department of Child & Adolescent Psychiatry, NYU Langone Medical Center, New York, NY, USA
| | - Chad Brice
- Department of Child & Adolescent Psychiatry, NYU Langone Medical Center, New York, NY, USA
| | - Kathleen Herzig
- Department of Child & Adolescent Psychiatry, NYU Langone Medical Center, New York, NY, USA
| | - Laura Mufson
- Department of Psychiatry, Columbia University College of Physicians and Surgeon and New York State Psychiatric Institute, New York, NY, USA
| | - Chelsea Lynch
- Department of Child & Adolescent Psychiatry, NYU Langone Medical Center, New York, NY, USA
| | - Philip T Reiss
- Nathan Kline Institute for Psychiatric Research, Orangeburg, NY, USA.,Department of Child & Adolescent Psychiatry, NYU Langone Medical Center, New York, NY, USA.,Department of Population Health, NYU Langone Medical Center, New York, NY, USA
| | - Eva Petkova
- Nathan Kline Institute for Psychiatric Research, Orangeburg, NY, USA.,Department of Child & Adolescent Psychiatry, NYU Langone Medical Center, New York, NY, USA.,Department of Population Health, NYU Langone Medical Center, New York, NY, USA
| | - Jeremy Fox
- Department of Child & Adolescent Psychiatry, NYU Langone Medical Center, New York, NY, USA
| | - Dominic C Moceri
- Department of Child & Adolescent Psychiatry, NYU Langone Medical Center, New York, NY, USA
| | - Julie Ryan
- Department of Child & Adolescent Psychiatry, NYU Langone Medical Center, New York, NY, USA
| | - Rachel G Klein
- Department of Child & Adolescent Psychiatry, NYU Langone Medical Center, New York, NY, USA
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Schmidt SJ, Schimmelmann BG. [Modular psychotherapy with children and adolescents]. ZEITSCHRIFT FUR KINDER-UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2016; 44:467-478. [PMID: 27356677 DOI: 10.1024/1422-4917/a000452] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The implementation of evidence-based psychotherapy with children and adolescents has been limited so far. This is mainly due to the fact that patients in service settings tend to have higher rates of comorbidities and more frequently changing therapy needs than those in research settings. Thus, modular psychotherapies are promising, as they allow the treatment protocol to be adapted to patients’ individual needs. Because no review on modular psychotherapy for children and adolescents exists, we conducted a systematic literature research. The results of the 15 randomized controlled trials identified demonstrate that modular psychotherapy is associated with significant reductions in symptom levels as well as with higher rates of diagnostic remission compared to control conditions. Because of the lack of evidence, future studies should investigate the incremental efficacy of modular approaches and test the validity of underlying theoretical models as well as of decision flowcharts. Modular psychotherapy approaches have the potential to personalize evidence-based interventions for children and adolescents across various therapeutical traditions, and to facilitate their implementation into clinical practice.
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Affiliation(s)
- Stefanie J Schmidt
- 1 Universitätsklinik für Kinder- und Jugendpsychiatrie und Psychotherapie, Universität Bern
| | - Benno G Schimmelmann
- 1 Universitätsklinik für Kinder- und Jugendpsychiatrie und Psychotherapie, Universität Bern
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Silk JS, Tan PZ, Ladouceur CD, Meller S, Siegle GJ, McMakin DL, Forbes EE, Dahl RE, Kendall PC, Mannarino A, Ryan ND. A Randomized Clinical Trial Comparing Individual Cognitive Behavioral Therapy and Child-Centered Therapy for Child Anxiety Disorders. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2016; 47:542-554. [PMID: 26983904 DOI: 10.1080/15374416.2016.1138408] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
This study compared individual cognitive behavioral therapy (CBT) and a supportive child-centered therapy (CCT) for child anxiety disorders on rates of treatment response and recovery at posttreatment and 1-year follow-up, as well as on real-world measures of emotional functioning. Youth (N = 133; ages 9-14) with anxiety disorders (generalized, separation, and/or social anxiety) were randomized using a 2:1 ratio to CBT (n = 90) or CCT (n = 43), which served as an active comparison. Treatment response and recovery at posttreatment and 1-year follow-up were assessed by Independent Evaluators, and youth completed ecological momentary assessment of daily emotions throughout treatment. The majority of youth in both CBT and CCT were classified as treatment responders (71.1% for CBT, 55.8% for CCT), but youth treated with CBT were significantly more likely to fully recover, no longer meeting diagnostic criteria for any of the targeted anxiety disorders and no longer showing residual symptoms (66.7% for CBT vs. 46.5% for CCT). Youth treated with CBT also reported significantly lower negative emotions associated with recent negative events experienced in daily life during the latter stages of treatment relative to youth treated with CCT. Furthermore, a significantly higher percentage of youth treated with CBT compared to CCT were in recovery at 1-year follow-up (82.2% for CBT vs. 65.1% for CCT). These findings indicate potential benefits of CBT above and beyond supportive therapy on the breadth, generalizability, and durability of treatment-related gains.
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Affiliation(s)
- Jennifer S Silk
- a Department of Psychology , University of Pittsburgh.,b Department of Psychiatry , University of Pittsburgh School of Medicine
| | - Patricia Z Tan
- c Department of Psychiatry and Biobehavioral Sciences , University of California, Los Angeles
| | - Cecile D Ladouceur
- b Department of Psychiatry , University of Pittsburgh School of Medicine
| | | | - Greg J Siegle
- b Department of Psychiatry , University of Pittsburgh School of Medicine
| | - Dana L McMakin
- b Department of Psychiatry , University of Pittsburgh School of Medicine
| | - Erika E Forbes
- b Department of Psychiatry , University of Pittsburgh School of Medicine
| | - Ronald E Dahl
- d School of Public Health , University of California at Berkeley
| | | | | | - Neal D Ryan
- b Department of Psychiatry , University of Pittsburgh School of Medicine
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Wergeland GJH, Fjermestad KW, Marin CE, Bjelland I, Haugland BSM, Silverman WK, Öst LG, Bjaastad JF, Oeding K, Havik OE, Heiervang ER. Predictors of treatment outcome in an effectiveness trial of cognitive behavioral therapy for children with anxiety disorders. Behav Res Ther 2015; 76:1-12. [PMID: 26583954 DOI: 10.1016/j.brat.2015.11.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 10/29/2015] [Accepted: 11/03/2015] [Indexed: 11/25/2022]
Abstract
A substantial number of children with anxiety disorders do not improve following cognitive behavioral therapy (CBT). Recent effectiveness studies have found poorer outcome for CBT programs than what is typically found in efficacy studies. The present study examined predictors of treatment outcome among 181 children (aged 8-15 years), with separation anxiety, social phobia, or generalized anxiety disorder, who participated in a randomized, controlled effectiveness trial of a 10-session CBT program in community clinics. Potential predictors included baseline demographic, child, and parent factors. Outcomes were as follows: a) remission from all inclusion anxiety disorders; b) remission from the primary anxiety disorder; and c) child- and parent-rated reduction of anxiety symptoms at post-treatment and at 1-year follow-up. The most consistent findings across outcome measures and informants were that child-rated anxiety symptoms, functional impairment, a primary diagnosis of social phobia or separation anxiety disorder, and parent internalizing symptoms predicted poorer outcome at post-treatment. Child-rated anxiety symptoms, lower family social class, lower pretreatment child motivation, and parent internalizing symptoms predicted poorer outcome at 1-year follow-up. These results suggest that anxious children with more severe problems, and children of parents with elevated internalizing symptom levels, may be in need of modified, additional, or alternative interventions to achieve a positive treatment outcome.
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Affiliation(s)
- Gro Janne H Wergeland
- Anxiety Research Network, Haukeland University Hospital, Bergen, Norway; Department of Child and Adolescent Psychiatry, Haukeland University Hospital, Bergen, Norway; Regional Centre for Child and Youth Mental Health and Child Welfare, Uni Research Health, Bergen, Norway.
| | - Krister W Fjermestad
- Anxiety Research Network, Haukeland University Hospital, Bergen, Norway; Frambu Resource Centre for Rare Disorders, Siggerud, Norway
| | - Carla E Marin
- Child Study Center, Yale University School of Medicine, New Haven, CT, USA
| | - Ingvar Bjelland
- Department of Child and Adolescent Psychiatry, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, Faculty of Medicine and Dentistry, University of Bergen, Norway
| | - Bente Storm Mowatt Haugland
- Anxiety Research Network, Haukeland University Hospital, Bergen, Norway; Regional Centre for Child and Youth Mental Health and Child Welfare, Uni Research Health, Bergen, Norway
| | - Wendy K Silverman
- Child Study Center, Yale University School of Medicine, New Haven, CT, USA
| | - Lars-Göran Öst
- Anxiety Research Network, Haukeland University Hospital, Bergen, Norway; Department of Clinical Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway; Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Department of Psychology, University of Stockholm, Stockholm, Sweden
| | - Jon Fauskanger Bjaastad
- Anxiety Research Network, Haukeland University Hospital, Bergen, Norway; Regional Centre for Child and Youth Mental Health and Child Welfare, Uni Research Health, Bergen, Norway; Division of Psychiatry, Stavanger University Hospital, Stavanger, Norway
| | - Kristin Oeding
- Anxiety Research Network, Haukeland University Hospital, Bergen, Norway
| | - Odd E Havik
- Anxiety Research Network, Haukeland University Hospital, Bergen, Norway; Department of Clinical Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway
| | - Einar R Heiervang
- Anxiety Research Network, Haukeland University Hospital, Bergen, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
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Robinson WL, Droege JR, Case MH, Jason LA. Reducing Stress and Preventing Anxiety in African American Adolescents: A Culturally- Grounded Approach. GLOBAL JOURNAL OF COMMUNITY PSYCHOLOGY PRACTICE 2015; 6:http://www.gjcpp.org/pdfs/Robinson-AnxietyCulturalCompetence-FINAL.pdf. [PMID: 27042702 PMCID: PMC4813807 DOI: 10.7728/0602201503] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Evidenced-based and culturally adapted stress-reduction interventions for urban African American adolescents who are at risk for anxiety and other problems related to stress are needed. This study presents intervention components and preliminary outcome findings of a culturally adapted stress-reduction intervention for urban African American adolescents. Preliminary findings support the efficacy of the intervention to reduce anxiety and enhance general cognitive competencies, such as coping strategies, self-efficacy, and positive thinking, among participants, in comparison to controls. Clinical implications of the stress-reduction intervention for the prevention of psychopathology, particularly among African American adolescents, are discussed.
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Drake KL, Stewart CE, Muggeo MA, Ginsburg GS. Enhancing the Capacity of School Nurses to Reduce Excessive Anxiety in Children: Development of the CALM Intervention. JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING 2015; 28:121-30. [PMID: 26171792 PMCID: PMC6013739 DOI: 10.1111/jcap.12115] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PROBLEM Excessive anxiety is among the most common psychiatric problems facing youth. Because anxious youth tend to have somatic complaints, many seek help from the school nurse. Thus, school nurses are in an ideal position to provide early intervention. This study addresses this problem and describes the plans to develop and test a new intervention (Child Anxiety Learning Modules; CALM), delivered by school nurses, to reduce child anxiety and improve academic functioning. METHODS An iterative development process including consultation with an expert panel, two open trials, and a pilot randomized controlled study comparing CALM to usual care is proposed. Feedback will be solicited from all participants during each phase and data on outcome measures will be provided by children, parents, teachers, and independent evaluators. FINDINGS Data will be collected on intervention satisfaction and feasibility. Primary outcomes that include child anxiety symptoms, classroom behavior, and school performance (e.g., attendance, grades, standardized test scores) will be collected at pre- and post-interventions and at a 3-month follow-up evaluation. CONCLUSIONS Pediatric anxiety is a common problem that school nurses frequently encounter. Consequently, they are well positioned to play a key role in enhancing access to behavioral health interventions to reduce anxiety and may therefore make a significant positive public health impact.
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Affiliation(s)
- Kelly L Drake
- The Johns Hopkins University School of Medicine, c/o Anxiety Treatment Center of Maryland, Ellicott City, MD, USA
| | | | - Michela A Muggeo
- Department of Psychiatry, University of Connecticut Health Center, West Hartford, CT, USA
| | - Golda S Ginsburg
- Department of Psychiatry, University of Connecticut Health Center, West Hartford, CT, USA
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An Open Trial of the Anxiety Action Plan ( AxAP): A Brief Pediatrician-Delivered Intervention for Anxious Youth. CHILD & YOUTH CARE FORUM 2015; 45:19-32. [PMID: 27403041 DOI: 10.1007/s10566-015-9320-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Anxiety disorders in youth are among the most common psychiatric disorders, yet the majority of affected youth do not receive treatment. One approach to improving access to care is identification and intervention within the primary care setting. OBJECTIVE This manuscript presents data from a single group pre-post open trial of the Anxiety Action Plan (AxAP), a brief pediatrician-delivered intervention to reduce anxiety in youth who present in the primary care setting. METHODS Eleven pediatricians conducted the intervention with 25 youth (mean age 11.16 years; range 6-18 years) with elevated levels of anxiety in their primary care practice setting. RESULTS Pediatricians' ratings of the AxAP training were positive (mean overall satisfaction was 4.82 on 5 point scale). Pediatricians and parents also reported high levels of intervention satisfaction and acceptability. Parents (but not children) who completed the intervention reported significant reductions from pre- to post-intervention on measures of child anxiety severity, impairment, and caregiver burden (Cohen's d 1.06, .75, .60, respectively). CONCLUSIONS Findings suggest that a brief, pediatrician-delivered intervention in primary care settings appears feasible and beneficial to patients. Additional controlled evaluation of the intervention's efficacy is needed.
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48
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James AC, James G, Cowdrey FA, Soler A, Choke A. Cognitive behavioural therapy for anxiety disorders in children and adolescents. Cochrane Database Syst Rev 2015; 2015:CD004690. [PMID: 25692403 PMCID: PMC6491167 DOI: 10.1002/14651858.cd004690.pub4] [Citation(s) in RCA: 100] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND A previous Cochrane review (James 2005) showed that cognitive behavioural therapy (CBT) was effective in treating childhood anxiety disorders; however, questions remain regarding (1) the relative efficacy of CBT versus non-CBT active treatments; (2) the relative efficacy of CBT versus medication and the combination of CBT and medication versus placebo; and (3) the long-term effects of CBT. OBJECTIVES To examine (1) whether CBT is an effective treatment for childhood and adolescent anxiety disorders in comparison with (a) wait-list controls; (b) active non-CBT treatments (i.e. psychological placebo, bibliotherapy and treatment as usual (TAU)); and (c) medication and the combination of medication and CBT versus placebo; and (2) the long-term effects of CBT. SEARCH METHODS Searches for this review included the Cochrane Central Register of Controlled Trials (CENTRAL) and the Cochrane Depression, Anxiety and Neurosis Group Register, which consists of relevant randomised controlled trials from the bibliographic databases-The Cochrane Library (1970 to July 2012), EMBASE, (1970 to July 2012) MEDLINE (1970 to July 2012) and PsycINFO (1970 to July 2012). SELECTION CRITERIA All randomised controlled trials (RCTs) of CBT versus waiting list, active control conditions, TAU or medication were reviewed. All participants must have met the criteria of the Diagnostic and Statistical Manual (DSM) or the International Classification of Diseases (ICD) for an anxiety diagnosis, excluding simple phobia, obsessive-compulsive disorder, post-traumatic stress disorder and elective mutism. DATA COLLECTION AND ANALYSIS The methodological quality of included trials was assessed by three reviewers independently. For the dichotomous outcome of remission of anxiety diagnosis, the odds ratio (OR) with 95% confidence interval (CI) based on the random-effects model, with pooling of data via the inverse variance method of weighting, was used. Significance was set at P < 0.05. Continuous data on each child's anxiety symptoms were pooled using the standardised mean difference (SMD). MAIN RESULTS Forty-one studies consisting of 1806 participants were included in the analyses. The studies involved children and adolescents with anxiety of mild to moderate severity in university and community clinics and school settings. For the primary outcome of remission of any anxiety diagnosis for CBT versus waiting list controls, intention-to-treat (ITT) analyses with 26 studies and 1350 participants showed an OR of 7.85 (95% CI 5.31 to 11.60, Z = 10.26, P < 0.0001), but with evidence of moderate heterogeneity (P = 0.04, I² = 33%). The number needed to treat (NNT) was 6.0 (95% CI 7.5 to 4.6). No difference in outcome was noted between individual, group and family/parental formats. ITT analyses revealed that CBT was no more effective than non-CBT active control treatments (six studies, 426 participants) or TAU in reducing anxiety diagnoses (two studies, 88 participants). The few controlled follow-up studies (n = 4) indicate that treatment gains in the remission of anxiety diagnosis are not statistically significant. AUTHORS' CONCLUSIONS Cognitive behavioural therapy is an effective treatment for childhood and adolescent anxiety disorders; however, the evidence suggesting that CBT is more effective than active controls or TAU or medication at follow-up, is limited and inconclusive.
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Affiliation(s)
- Anthony C James
- University of Oxford Department of Psychiatry, University of Oxford, Oxford, UK, OX3 7JX.
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Nail JE, Christofferson J, Ginsburg GS, Drake K, Kendall PC, McCracken JT, Birmaher B, Walkup JT, Compton SN, Keeton C, Sakolsky D. Academic Impairment and Impact of Treatments Among Youth with Anxiety Disorders. CHILD & YOUTH CARE FORUM 2014. [DOI: 10.1007/s10566-014-9290-x] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Glover M, Kira A, Johnston V, Walker N, Thomas D, Chang AB, Bullen C, Segan CJ, Brown N. A systematic review of barriers and facilitators to participation in randomized controlled trials by Indigenous people from New Zealand, Australia, Canada and the United States. Glob Health Promot 2014; 22:21-31. [PMID: 24842989 DOI: 10.1177/1757975914528961] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
ISSUE Many randomized controlled trials (RCTs) are conducted each year but only a small proportion is specifically designed for Indigenous people. In this review we consider the challenges of participation in RCTs for Indigenous peoples from New Zealand, Australia, Canada and the United States and the opportunities for increasing participation. APPROACH The literature was systematically searched for published articles including information on the barriers and facilitators for Indigenous people's participation in health-related RCTs. Articles were identified using a key word search of electronic databases (Scopus, Medline and EMBASE). To be included, papers had to include in their published work at least one aspect of their RCT that was either a barrier and/or facilitator for participation identified from, for example, design of intervention, or discussion sections of articles. Articles that were reviews, discussions, opinion pieces or rationale/methodology were excluded. Results were analysed inductively, allowing themes to emerge from the data. KEY FINDINGS Facilitators enabling Indigenous people's participation in RCTs included relationship and partnership building, employing Indigenous staff, drawing on Indigenous knowledge models, targeted recruitment techniques and adapting study material. Challenges for participation included both participant-level factors (such as a distrust of research) and RCT-level factors (including inadequately addressing likely participant barriers (phone availability, travel costs), and a lack of recognition or incorporation of Indigenous knowledge systems. IMPLICATION The findings from our review add to the body of knowledge on elimination of health disparities, by identifying effective and practical strategies for conducting and engaging Indigenous peoples with RCTs. Future trials that seek to benefit Indigenous peoples should actively involve Indigenous research partners, and respect and draw on pertinent Indigenous knowledge and values. This review has the potential to assist in the design of such studies.
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Affiliation(s)
- Marewa Glover
- Centre for Tobacco Control Research, University of Auckland, New Zealand
| | - Anette Kira
- Centre for Tobacco Control Research, University of Auckland, New Zealand
| | - Vanessa Johnston
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Natalie Walker
- National Institute for Health Innovation, University of Auckland, New Zealand
| | - David Thomas
- Menzies School of Health Research, Charles Darwin University and the Lowitja Institute, Darwin, Australia
| | - Anne B Chang
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Chris Bullen
- National Institute for Health Innovation, University of Auckland, New Zealand
| | - C J Segan
- Centre for Health Policy, Programs and Economics, University of Melbourne, Australia
| | - Ngiare Brown
- Menzies School of Health Research, Charles Darwin University and the Lowitja Institute, Darwin, Australia
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