Cognitive-behavioral therapy for anxiety disorders in children and adolescents: a systematic review of follow-up studies

Intervention for Treating Depression in Parents of Children with Intellectual Disability of Down's Syndrome: A Sample of Nigerian Parents

A good number of parents of children with Down syndrome are prone to depressive disorders. The depressive feelings are attributed to negative perceptions of the situation, self, and the future. Given this, we explored the impact of the family health model of rational-emotive behavior therapy on depressive symptoms in parents of children with intellectual disability of Down syndrome in the COVID-19 pandemic era. This is a randomized pretest-posttest control group design that recruited 88 parents of children with intellectual disability of Down syndrome. We measured the depressive symptoms in parents at Time 1, Time 2, and Time 3 using the Beck depressive inventory and Hamilton depression rating scale. We adopted a family health model rational emotive behaviour therapy intervention in treating the depressive symptoms affecting the parents. The analysis of covariate results showed that at initial assessment there was no significant difference between the treatment group and comparison group at baseline evaluation of depressive symptoms in participants. At the posttest, it had a significant effect on the intervention on participants' depressive symptoms. Likewise, a follow-up result still shows that intervention had a significant effect on participants' depressive symptoms of participants. In conclusion, this study suggests that treatment variable accounted for the effect in decreasing depressive symptoms scores of participants.

Cognitive-behavioural therapy for a variety of conditions: an overview of systematic reviews and panoramic meta-analysis

BACKGROUND

Cognitive-behavioural therapy aims to increase quality of life by changing cognitive and behavioural factors that maintain problematic symptoms. A previous overview of cognitive-behavioural therapy systematic reviews suggested that cognitive-behavioural therapy was effective for many conditions. However, few of the included reviews synthesised randomised controlled trials.

OBJECTIVES

This project was undertaken to map the quality and gaps in the cognitive-behavioural therapy systematic review of randomised controlled trial evidence base. Panoramic meta-analyses were also conducted to identify any across-condition general effects of cognitive-behavioural therapy.

DATA SOURCES

The overview was designed with cognitive-behavioural therapy patients, clinicians and researchers. The Cochrane Library, MEDLINE, EMBASE, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, Child Development & Adolescent Studies, Database of Abstracts of Reviews of Effects and OpenGrey databases were searched from 1992 to January 2019.

REVIEW METHODS

Study inclusion criteria were as follows: (1) fulfil the Centre for Reviews and Dissemination criteria; (2) intervention reported as cognitive-behavioural therapy or including one cognitive and one behavioural element; (3) include a synthesis of cognitive-behavioural therapy trials; (4) include either health-related quality of life, depression, anxiety or pain outcome; and (5) available in English. Review quality was assessed with A MeaSurement Tool to Assess systematic Reviews (AMSTAR)-2. Reviews were quality assessed and data were extracted in duplicate by two independent researchers, and then mapped according to condition, population, context and quality. The effects from high-quality reviews were pooled within condition groups, using a random-effect panoramic meta-analysis. If the across-condition heterogeneity was I2 < 75%, we pooled across conditions. Subgroup analyses were conducted for age, delivery format, comparator type and length of follow-up, and a sensitivity analysis was performed for quality.

RESULTS

A total of 494 reviews were mapped, representing 68% (27/40) of the categories of the International Classification of Diseases, Eleventh Revision, Mortality and Morbidity Statistics. Most reviews (71%, 351/494) were of lower quality. Research on older adults, using cognitive-behavioural therapy preventatively, ethnic minorities and people living outside Europe, North America or Australasia was limited. Out of 494 reviews, 71 were included in the primary panoramic meta-analyses. A modest effect was found in favour of cognitive-behavioural therapy for health-related quality of life (standardised mean difference 0.23, 95% confidence interval 0.05 to 0.41, prediction interval -0.05 to 0.50, I2 = 32%), anxiety (standardised mean difference 0.30, 95% confidence interval 0.18 to 0.43, prediction interval -0.28 to 0.88, I2 = 62%) and pain (standardised mean difference 0.23, 95% confidence interval 0.05 to 0.41, prediction interval -0.28 to 0.74, I2 = 64%) outcomes. All condition, subgroup and sensitivity effect estimates remained consistent with the general effect. A statistically significant interaction effect was evident between the active and non-active comparator groups for the health-related quality-of-life outcome. A general effect for depression outcomes was not produced as a result of considerable heterogeneity across reviews and conditions.

LIMITATIONS

Data extraction and analysis were conducted at the review level, rather than returning to the individual trial data. This meant that the risk of bias of the individual trials could not be accounted for, but only the quality of the systematic reviews that synthesised them.

CONCLUSION

Owing to the consistency and homogeneity of the highest-quality evidence, it is proposed that cognitive-behavioural therapy can produce a modest general, across-condition benefit in health-related quality-of-life, anxiety and pain outcomes.

FUTURE WORK

Future research should focus on how the modest effect sizes seen with cognitive-behavioural therapy can be increased, for example identifying alternative delivery formats to increase adherence and reduce dropout, and pursuing novel methods to assess intervention fidelity and quality.

STUDY REGISTRATION

This study is registered as PROSPERO CRD42017078690.

FUNDING

This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 9. See the NIHR Journals Library website for further project information.

Impacts of cognitive-behavioral intervention on anxiety and depression among social science education students: A randomized controlled trial

BACKGROUND

Anxiety is a common disorder which refers to a significant and persistent fear of one or more social or performance situations. This study investigated the impacts of cognitive-behavioral intervention on anxiety and depression among undergraduate students enrolled in social science education programs at public universities in the Southeast Nigeria.

METHODS

Participants were 55 undergraduate students enrolled in social science education programs at public universities in the Southeast Nigeria. The adequacy of the sample size used was determined using GPower software. Cognitive-behavioral treatment manuals on anxiety and depression were used to deliver the intervention. Data analyses were completed using repeated measures analysis of variance.

RESULTS

Results indicated a significant positive impact of cognitive-behavioral intervention on anxiety and depression among social science education students exposed to the cognitive-behavioral intervention when compared to the waitlisted group. Results also showed that there was a significant time × group interaction for anxiety and depression. Follow-up tests showed that significant reduction in anxiety and depression persisted after 3 months for the cognitive-behavioral intervention group in comparison to the waitlisted control group.

CONCLUSION

We concluded that cognitive-behavioral intervention was a successful intervention which decreased the symptoms of anxiety and depression in social science education students who participated in the study. Additional studies are recommended to further corroborate the influence of cognitive-behavioral intervention in the reduction of anxiety and depressive symptoms in the Nigerian undergraduate student population.

Long-Term Outcomes of Youth Treated for an Anxiety Disorder: A Critical Review

Pediatric anxiety disorders are common, disabling, and chronic conditions. Efforts over the past two decades have focused on developing and testing effective treatments. Short-term efficacy of both Cognitive Behavioral Therapy (CBT) and selective serotonin reuptake inhibitors has been established. Data are emerging on the long-term (i.e., 2 years or longer) effectiveness of these treatments, but this literature has yet to be adequately synthesized. This study presents a systematic and critical qualitative review of published long-term follow-up (LTFU) studies of youth treated for an anxiety disorder. A comprehensive search of several databases identified 21 published reports (representing 15 LTFU cohorts of treated youth) meeting specified inclusion criteria. LTFU assessments occurred a mean of 5.85 years after initial treatment (range 2-19 years). Diagnostic rates at LTFU and predictors (e.g., demographic, baseline child clinical variables, treatment type) of outcomes at LTFU were also examined. A discussion of the limitations of this literature is provided to qualify interpretations of findings and to inform future studies. Findings can aid clinicians and families in making treatment decisions and setting reasonable expectations for the long-term prognosis after treatment for anxiety.