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Lamsal R, Yeh EA, Pullenayegum E, Ungar WJ. A Systematic Review of Methods Used by Pediatric Cost-Utility Analyses to Include Family Spillover Effects. PHARMACOECONOMICS 2024; 42:199-217. [PMID: 37945777 PMCID: PMC10810985 DOI: 10.1007/s40273-023-01331-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/25/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND A child's health condition affects family members' health and well-being. However, pediatric cost-utility analysis (CUA) commonly ignores these family spillover effects leading to an incomplete understanding of the cost and benefits of a child's health intervention. Methodological challenges exist in assessing, valuing, and incorporating family spillover effects. OBJECTIVE This study systematically reviews and compare methods used to include family spillover effects in pediatric CUAs. METHODS A literature search was conducted in MEDLINE, Embase, EconLit, Cochrane collection, CINAHL, INAHTA, and the Pediatric Economic Database Evaluation (PEDE) database from inception to 2020 to identify pediatric CUAs that included family spillover effects. The search was updated to 2021 using PEDE. The data describing in which family members spillover effects were measured, and how family spillover effects were measured, incorporated, and reported, were extracted. Common approaches were grouped conceptually. Further, this review identified theories or theoretical frameworks used to justify approaches for integrating family spillover effects into CUA. RESULTS Of 878 pediatric CUAs identified, 35 included family spillover effects. Most pediatric CUAs considered family spillover effects on one family member. Pediatric CUAs reported eight different approaches to measure the family spillover effects. The most common method was measuring the quality-adjusted life years (QALY) loss of the caregiver(s) or parent(s) due to a child's illness or disability using an isolated approach whereby family spillover effects were quantified in individual family members separately from other health effects. Studies used four approaches to integrate family spillover effects into CUA. The most common method was to sum children's and parents/caregivers' QALYs. Only two studies used a theoretical framework for incorporation of family spillover effects. CONCLUSIONS Few pediatric CUAs included family spillover effects and the observed variation indicated no consensus among researchers on how family spillover effects should be measured and incorporated. This heterogeneity is mirrored by a lack of practical guidelines by Health Technology Assessment (HTA) agencies or a theoretical foundation for including family spillover effects in pediatric CUA. The results from this review may encourage researchers to develop a theoretical framework and HTA agencies to develop guidelines for including family spillover effects. Such guidance may lead to more rigorous and standardized methods for including family spillover effects and better-quality evidence to inform decision-makers on the cost-effectiveness of pediatric health interventions.
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Affiliation(s)
- Ramesh Lamsal
- Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, 686 Bay Street, 11th Floor, Toronto, ON, M5G 0A4, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - E Ann Yeh
- Division of Neurology, Department of Pediatrics, University of Toronto, Toronto, ON, Canada
- Neurosciences and Mental Health, SickKids Research Institute, Toronto, ON, Canada
| | - Eleanor Pullenayegum
- Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, 686 Bay Street, 11th Floor, Toronto, ON, M5G 0A4, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Wendy J Ungar
- Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, 686 Bay Street, 11th Floor, Toronto, ON, M5G 0A4, Canada.
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
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Leigh LH, Doyle FL, Hudson JL. Increasing the Efficacy of Treatment for Socially Anxious Youth Through Theoretically Derived Improvements: A Pilot Study. Child Psychiatry Hum Dev 2023; 54:1653-1665. [PMID: 35507090 PMCID: PMC10582123 DOI: 10.1007/s10578-022-01351-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/11/2022] [Indexed: 11/27/2022]
Abstract
Cognitive behavioural therapy is the first line of treatment for social anxiety disorder; however, children with social anxiety disorder do not respond as well to generic cognitive behavioural therapy programs, compared to children with other anxiety disorders. The aim of the study was to provide a preliminary examination of the efficacy and applicability of a new disorder specific intervention for children with social anxiety disorder. Five children aged 7-13 years, with a primary or secondary DSM-5 diagnosis of social anxiety disorder were provided with an adapted version of the Cool Kids anxiety program. Three out of the five children were in remission from social anxiety disorder at the end of the intervention and at 3-month follow-up. Statistically significant improvements were also noted in overall anxiety symptoms and functioning. Preliminary evidence was found for the efficacy of a social anxiety version of the Cool Kids program.
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Affiliation(s)
- Lynda H Leigh
- Department of Psychology, Centre for Emotional Health, Macquarie University, Sydney, Australia
| | - Frances L Doyle
- MARCS Institute for Brain, Behaviour and Development, School of Psychology, Western Sydney University, Penrith, Australia
| | - Jennifer L Hudson
- Black Dog Institute, University of New South Wales, Sydney, Australia.
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Li P, Wang C, Zhou R, Tan L, Deng X, Zhu T, Chen G, Li W, Hao X. Development and evaluation of a data-driven integrated management app for perioperative adverse events: protocol for a mixed-design study. BMJ Open 2023; 13:e069754. [PMID: 37192808 DOI: 10.1136/bmjopen-2022-069754] [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: 05/18/2023] Open
Abstract
INTRODUCTION A patient record review study conducted in 2006 in a random sample of 21 Dutch hospitals found that 51%-77% of adverse events are related to perioperative care, while Centers for Disease Control and Prevention data in USA in 2013 estimated that the medical error is the third-leading cause of mortality. To capitalise on the potential of apps to enhance perioperative medical quality, there is a need for interventions developed in consultation with real-world users designed to support integrated management for perioperative adverse events (PAEs). This study aims: (1) to access the knowledge, attitude and practices for PAEs among physicians, nurses and administrators, and to identify the needs of healthcare providers for a mobile-based PAEs tool; (2) to develop a data-driven app for integrated PAE management that meets those needs and (3) to test the usability, clinical efficacy and cost-effectiveness of the developed app. METHODS AND ANALYSIS We will adopt an embedded mixed-methods research technique; qualitative data will be used to assess user needs and app adoption, while quantitative data will provide crucial insights to establish the demand for the app, and measure the app effects. Phase 1 will enrol surgery-related healthcare providers from the West China Hospital and identify their latent demand for mobile-based PAEs management using a self-designed questionnaire underpinned by the knowledge, attitude and practice model, as well as expert interviews. In phase 2, we will develop the app for integrated PAE management and test its effectiveness and sustainability. In phase 3, the effects on the total number and severity of reported PAEs will be evaluated using Poisson regression with interrupted time-series analysis over a 2-year period, while users' engagement, adherence, process evaluation and cost-effectiveness will be evaluated using quarterly surveys and interviews. ETHICS AND DISSEMINATION The West China Hospital of Sichuan University's Institutional Review Board authorised this study after approving the study protocol, permission forms and questionnaires (number: 2022-1364). Participants will be provided with study information, and informed written consent will be obtained. Study findings will be disseminated through peer-reviewed publications and conference presentations.
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Affiliation(s)
- Peiyi Li
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Research Unit for Perioperative Stress Assessment and Clinical Decision, Chinese Academy of Medical Sciences (2018RU012), West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Laboratory of Anesthesia and Critical Care Medicine, National-Local Joint Engineering Research Centre of Translational Medicine of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ce Wang
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Research Unit for Perioperative Stress Assessment and Clinical Decision, Chinese Academy of Medical Sciences (2018RU012), West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ruihao Zhou
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Research Unit for Perioperative Stress Assessment and Clinical Decision, Chinese Academy of Medical Sciences (2018RU012), West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Lingcan Tan
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xiaoqian Deng
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Tao Zhu
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Research Unit for Perioperative Stress Assessment and Clinical Decision, Chinese Academy of Medical Sciences (2018RU012), West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Guo Chen
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Research Unit for Perioperative Stress Assessment and Clinical Decision, Chinese Academy of Medical Sciences (2018RU012), West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Weimin Li
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Frontiers Science Center for Disease-Related Molecular Network, Institute of Respiratory Health, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- President's Office, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xuechao Hao
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Research Unit for Perioperative Stress Assessment and Clinical Decision, Chinese Academy of Medical Sciences (2018RU012), West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Palmer E, Woolgar M, Carter B, Cartwright-Hatton S, Challacombe FL. Preventing anxiety in the children of anxious parents - feasibility of a brief, online, group intervention for parents of one- to three-year-olds. Child Adolesc Ment Health 2023; 28:33-41. [PMID: 35983606 DOI: 10.1111/camh.12596] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/22/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND The evidence suggests an increased risk of developing anxiety problems in children of anxious parents. The current study explored the feasibility and acceptability of an intervention with anxious parents of young children, to inform the possibility of further trials. METHODS Participants were recruited through primary and secondary care psychological services and social media. Participants who had a current or recent anxiety disorder and a child aged 12-47 months were included. Assessments of parental and child outcomes occurred at baseline, after the intervention (week-2) and follow-up (week-8). The intervention was delivered in a small group format, in two sessions, one week apart, using videoconferencing. RESULTS Out of 32 participants, 30 (94%) attended the full intervention. All found the intervention acceptable and reported it as useful and relevant. There was a reduction in parental depression (MD = 2.63, 95%CI 1.01-4.26), anxiety (MD = 3.93, 95%CI 2.49-5.37) and stress (MD = 4.60, 95% CI 3.02-6.18) and increases in parenting confidence. CONCLUSIONS The online group intervention was feasible and acceptable. There were moderate to large effects on parental mental health and no adverse effects on children (decline on outcome measures). This indicates that intervening early in parenting with anxious parents is possible and warrants further investigation to establish prevention efficacy with a larger, controlled trial.
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Affiliation(s)
- Emily Palmer
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Matt Woolgar
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Ben Carter
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | | | - Fiona L Challacombe
- Section of Women's Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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Scope A, Bhadhuri A, Pennington B. Systematic Review of Cost-Utility Analyses That Have Included Carer and Family Member Health-Related Quality of Life. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2022; 25:1644-1653. [PMID: 35339379 DOI: 10.1016/j.jval.2022.02.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 02/03/2022] [Accepted: 02/07/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVES Health interventions for patients can also affect the health of their informal carers and family members. These changes in carer or family member health could be reflected in cost-utility analyses (CUAs) through the inclusion of their quality-adjusted life-years (QALYs). We conducted a systematic review to identify and describe all CUAs that have included family member health-related QALYs. METHODS A total of 4 bibliographic databases were searched from inception to July 2021. A 2-stage sifting process for inclusion of studies was undertaken. We performed data extraction using a standardized data extraction form and performed a narrative synthesis of the evidence. RESULTS A total of 40 CUAs published between 1999 and 2021 were identified. CUAs were conducted in 15 different countries. CUAs examined 13 different conditions including 15 CUAs on vaccination, 5 on Alzheimer's disease, 2 on Parkinson's disease, 3 on dementia, and 2 on terminal illness. The EQ-5D was the most commonly used measure of family member health. Generally, including carer QALYs resulted in lower incremental cost-effectiveness ratios. CONCLUSIONS When considering the total number of economic evaluations published, few have included family member QALYs and the methods for doing so are often inconsistent and data sources often limited. Estimation of family member QALYs in patient CUAs was regularly uncertain and often substantial in magnitude. The findings highlight the variation among methods and call for greater consistency in methods for incorporating family member QALYs in patient CUAs.
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Affiliation(s)
- Alison Scope
- School of Health and Related Research, University of Sheffield, Sheffield, England, UK.
| | - Arjun Bhadhuri
- Institute of Pharmaceutical Medicine (ECPM), University of Basel, Basel, Switzerland.
| | - Becky Pennington
- School of Health and Related Research, University of Sheffield, Sheffield, England, UK
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De Nadai AS, Quast T, Little TB, Westerberg K, Patyk KC, Monahan MF, Storch EA, Gregory ST. Intervention cost-effectiveness for pediatric anxiety and OCD: A systematic review and integrated database model. J Affect Disord 2022; 298:110-118. [PMID: 34728286 DOI: 10.1016/j.jad.2021.10.127] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 09/30/2021] [Accepted: 10/20/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND While multiple treatments for pediatric anxiety and obsessive compulsive disorder (OCD) are efficacious, little is known about their cost-effectiveness. In response, we sought to provide relevant information through systematic review and cost-effectiveness simulation. METHODS We evaluated the cost-effectiveness of treatment for pediatric anxiety and OCD in two ways. First, we conducted a systematic review following PRISMA guidelines. Second, we evaluated cost-effectiveness for antidepressant medication, cognitive behavioral therapy, and their combination via a simulation that integrated information from the Truven MarketScan database and the NIMH National Database for Clinical Trials Related to Mental Illness. RESULTS Both systematic review and simulation found antidepressant medication and cognitive behavioral therapy to be cost-effective for pediatric anxiety and OCD. Antidepressant medication was the least costly approach, and cognitive behavioral therapy provided additional cost-effectiveness, especially for OCD. LIMITATIONS During systematic review, relatively few articles provided information about both costs and effectiveness. While there was a notable margin of error to support multiple interventions as cost-effective, limited prior research decreased precision of point estimates and comparisons between interventions. CONCLUSIONS Both antidepressant medication and cognitive behavioral therapy were found to be cost-effective for pediatric anxiety and OCD. Results supported investment from third party payers, who serve as critical gatekeepers that can increase treatment dissemination. However, more precise information would better inform the exact amount of investment needed, especially with regard to selection decisions between active interventions. Cost-effectiveness research would benefit from systematic collection of data on treatment costs and quality of life in future clinical trials.
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Affiliation(s)
| | - Troy Quast
- University of South Florida, 13201 Bruce B. Downs Blvd., Tampa, FL 33620, USA
| | - Tara B Little
- Texas State University, 601 University Drive, UAC 253L, San Marcos, TX 78666, USA
| | - Kaitlyn Westerberg
- Texas State University, 601 University Drive, UAC 253L, San Marcos, TX 78666, USA
| | - Kevin C Patyk
- Texas State University, 601 University Drive, UAC 253L, San Marcos, TX 78666, USA
| | - Maureen F Monahan
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, 1051 Riverside Drive, New York, NY 10032, USA; New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA
| | - Eric A Storch
- Baylor College of Medicine, 1977 Butler Blvd, Houston, TX 77030, USA
| | - Sean T Gregory
- Baylor College of Medicine, 1977 Butler Blvd, Houston, TX 77030, USA; Magellan Health, 6303 Cowboys Way, Frisco, TX 75034, USA
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Bennett SD, Kerry E, Fifield K, Ching BCF, Catanzano M, Liang H, Heyman I, Coughtrey AE, Sanderson C, Rojas N, Shafran R. A drop-in centre for treating mental health problems in children with chronic illness: Outcomes for parents and their relationship with child outcomes. JCPP ADVANCES 2021; 1:e12046. [PMID: 37431405 PMCID: PMC10242943 DOI: 10.1002/jcv2.12046] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 09/14/2021] [Indexed: 11/07/2022] Open
Abstract
Background Children with chronic health conditions and their parents are at greater risk of developing emotional and behavioural problems compared to their physically healthy peers. The psychological impact on parents is crucial to understand given the relationship between parental mental health and child emotional and behavioural difficulties. This study was part of a broader research project examining the acceptability, feasibility and impact of a 'Mental Health and Psychological Wellbeing Drop-in Centre' in a paediatric hospital providing access to support and intervention for children and their families. This paper aimed to investigate the impact of the centre on parents (n = 148). Methods Parental anxiety and depression were assessed using the GAD-7 and PHQ-9 at baseline and 6-month post-baseline. Child mental health was assessed using the parent-report Strengths and Difficulties Questionnaire (SDQ). If parents had significant mental health needs, a brief intervention/signposting to relevant services was provided. Results At baseline, 48% of parents scored above clinical threshold for anxiety and 41% for depression, and parent reported child SDQ scores were correlated with parental anxiety and parental low mood. Self-reported parental anxiety and low mood decreased at 6-months post-baseline (parental anxiety: mean decrease = 2.29 [1.22-3.36], d = 0.38; parental low mood: mean decrease = 1.81 [0.64-3.00], d = 0.28). There were no significant correlations between change in parent reported child wellbeing and changes in parental low mood and anxiety between baseline and 6-month post-baseline. Conclusions Assessing and providing a brief treatment to address the mental health needs of parents of children with comorbidity may bring important benefits. It is recommended that children's mental health services consider assessment of parental mental health as part of routine care.
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Affiliation(s)
- Sophie D. Bennett
- UCL Great Ormond Street Institute of Child HealthLondonUK
- Great Ormond Street Hospital for Children NHS Foundation TrustLondonUK
| | - Eleanor Kerry
- UCL Great Ormond Street Institute of Child HealthLondonUK
- Great Ormond Street Hospital for Children NHS Foundation TrustLondonUK
| | - Kate Fifield
- UCL Great Ormond Street Institute of Child HealthLondonUK
- Great Ormond Street Hospital for Children NHS Foundation TrustLondonUK
| | - Brian C. F. Ching
- UCL Great Ormond Street Institute of Child HealthLondonUK
- Great Ormond Street Hospital for Children NHS Foundation TrustLondonUK
| | - Matteo Catanzano
- UCL Great Ormond Street Institute of Child HealthLondonUK
- Great Ormond Street Hospital for Children NHS Foundation TrustLondonUK
| | - Holan Liang
- UCL Great Ormond Street Institute of Child HealthLondonUK
- Great Ormond Street Hospital for Children NHS Foundation TrustLondonUK
| | - Isobel Heyman
- UCL Great Ormond Street Institute of Child HealthLondonUK
- Great Ormond Street Hospital for Children NHS Foundation TrustLondonUK
| | - Anna E. Coughtrey
- UCL Great Ormond Street Institute of Child HealthLondonUK
- Great Ormond Street Hospital for Children NHS Foundation TrustLondonUK
| | - Charlotte Sanderson
- UCL Great Ormond Street Institute of Child HealthLondonUK
- Great Ormond Street Hospital for Children NHS Foundation TrustLondonUK
| | - Natalia Rojas
- UCL Great Ormond Street Institute of Child HealthLondonUK
- Great Ormond Street Hospital for Children NHS Foundation TrustLondonUK
| | - Roz Shafran
- UCL Great Ormond Street Institute of Child HealthLondonUK
- Great Ormond Street Hospital for Children NHS Foundation TrustLondonUK
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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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Peris TS, Thamrin H, Rozenman MS. Family Intervention for Child and Adolescent Anxiety: A Meta-analytic Review of Therapy Targets, Techniques, and Outcomes. J Affect Disord 2021; 286:282-295. [PMID: 33756306 DOI: 10.1016/j.jad.2021.02.053] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 02/02/2021] [Accepted: 02/22/2021] [Indexed: 11/25/2022]
Abstract
Parent- and family-level correlates of youth anxiety are well-documented, and they highlight potential targets for family-focused intervention. Although family-based approaches for treating youth anxiety generally are considered efficacious for achieving symptom reduction, they vary in format and approach and it remains unclear whether they offer an advantage over individual child treatment. To better understand the current state of the evidence, we used meta-analytic methods to examine the therapeutic approaches described in existing family interventions for child and adolescent anxiety, whether they mapped to the major mechanisms proposed in the literature, and the timeline along which relevant parent/family variables were measured. We examined how these mechanism-focused family interventions performed in RCTs relative to individual child CBT and whether they shifted symptoms and relevant parenting behaviors. A total of 11 randomized controlled trials (RCTs) compared individual cognitive behavior therapy (CBT) to CBT+ a family component (CBT + FAM) and included a youth anxiety measure at pre- and post-treatment; only half of these (n=6) also included a parent/family functioning measure at both pre- and post-treatment (across both primary and secondary outcome papers). Only a single study included anxiety measures at a mid-treatment time point, and none included parent measures at a mid-treatment time point. Findings are discussed in terms of design considerations and advancing the field of family intervention for youth anxiety.
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Affiliation(s)
- Tara S Peris
- Division of Child & Adolescent Psychiatry, Jane & Terry Semel Institute for Neuroscience at UCLA, Los Angeles, CA 90024.
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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: 42] [Impact Index Per Article: 10.5] [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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Reardon T, Spence SH, Hesse J, Shakir A, Creswell C. Identifying children with anxiety disorders using brief versions of the Spence Children's Anxiety Scale for children, parents, and teachers. Psychol Assess 2018; 30:1342-1355. [PMID: 29902050 PMCID: PMC6179143 DOI: 10.1037/pas0000570] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Anxiety disorders are among the most prevalent mental health disorders experienced by children and are associated with significant negative outcomes. Only a minority of affected children, however, access professional help, and a failure to identify children with anxiety disorders presents a key barrier to treatment access. Existing child anxiety questionnaire measures are long and time consuming to complete, limiting their potential for widespread use as identification tools in community settings. We developed a brief questionnaire for parents, children, and teachers using items from the Spence Children’s Anxiety Scale (SCAS) and evaluated the new measure’s psychometric properties, capacity to discriminate between a community (n = 361) and clinic-referred sample (n = 338) of children aged 7–11, and identified optimal cut-off scores for accurate identification of preadolescent children experiencing clinically significant levels of anxiety. The findings provided support for the reliability and validity of 8-item versions of the SCAS, with the brief questionnaire scores displaying comparable internal consistency, agreement among reporters, and convergent/divergent validity to the full-length SCAS scores. The brief SCAS scores also discriminated between the community and clinic-referred samples and identified children in the clinic-referred sample with a moderate-to-good level of accuracy and acceptable sensitivity and specificity. Combining reporters improved sensitivity, but at the expense of specificity, and findings suggested parent report should be prioritized. This new brief questionnaire has potential for use in community settings as a tool to improve identification of children who are experiencing clinically significant levels of anxiety and warrant further assessment and potential support. We developed and evaluated brief versions of the Spence Children’s Anxiety Scale for parents, children, and teachers. Results provide support for the potential application of this new brief questionnaire in community settings to improve identification of children with anxiety disorders.
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Affiliation(s)
| | - Susan H Spence
- School of Applied Psychology and Australian Institute of Suicide Research and Prevention, Griffith University
| | - Jordan Hesse
- School of Psychology and Clinical Language Sciences, University of Reading
| | - Alia Shakir
- School of Psychology and Clinical Language Sciences, University of Reading
| | - Cathy Creswell
- School of Psychology and Clinical Language Sciences, University of Reading
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12
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Johnson MJ, Yorke J, Hansen-Flaschen J, Ekström M, Currow DC. Chronic breathlessness: re-thinking the symptom. Eur Respir J 2018; 51:51/4/1800340. [PMID: 29650550 DOI: 10.1183/13993003.00340-2018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 02/16/2018] [Indexed: 01/05/2023]
Affiliation(s)
- Miriam J Johnson
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Janelle Yorke
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | - John Hansen-Flaschen
- Perelman School of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Magnus Ekström
- Dept of Clinical Sciences, Division of Respiratory Medicine and Allergology, Lund University, Lund, Sweden
| | - David C Currow
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK.,Faculty of Health, University of Technology Sydney, Sydney, Australia
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Noonan K, Burns R, Violato M. Family income, maternal psychological distress and child socio-emotional behaviour: Longitudinal findings from the UK Millennium Cohort Study. SSM Popul Health 2018; 4:280-290. [PMID: 29854912 PMCID: PMC5976845 DOI: 10.1016/j.ssmph.2018.03.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2017] [Revised: 03/01/2018] [Accepted: 03/06/2018] [Indexed: 11/16/2022] Open
Abstract
The association between low family income and socio-emotional behaviour problems in early childhood has been well-documented, and maternal psychological distress is highlighted as central in mediating this relationship. However, whether this relationship holds for older children, and the precise mechanisms by which income may influence child behaviour is unclear. This study investigated the relationship between family income and child socio-emotional behaviour at 11 years of age, and examined the mediating role of maternal psychological distress over time using the UK Millennium Cohort Study. The primary outcome was parent-reported behavioural problems, as captured by the Total Difficulties Score (TDS), derived from the Strengths and Difficulties Questionnaire (SDQ). Secondary outcomes were the emotional, peer-related, conduct, and hyperactivity/inattention problems subscales of the SDQ; and teacher-reported TDS. Permanent family income was the primary exposure variable; frequency of poverty up to age 11 years was the secondary exposure variable. Maternal psychological distress was operationalised to reflect the trajectory from child birth to age 11. Multivariable logistic regression models were used to estimate the effect of permanent family income on child behaviour at age 11, controlling for maternal psychological distress and other relevant covariates. Results showed a statistically significant protective effect of increased permanent family income on the likelihood of behavioural problems at age 11. This finding was consistent for all SDQ subscales apart from emotional problems, and was strongest for teacher-reported behavioural problems. Maternal distress was an important mediator in the income-child behaviour relationship for parent-reported, but not teacher-reported, behavioural problems. The results of this study strengthen empirical evidence that the child behaviour-income gradient is maintained in older childhood. Mother's psychological distress, particularly longstanding or recurrent, appears to contribute to this relationship. These findings may validate calls for psychosocial and financial supports for families affected by parental mental health issues.
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Affiliation(s)
| | | | - Mara Violato
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Roosevelt Drive, Oxford OX3 7LF, United Kingdom
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Pearcey S, Alkozei A, Chakrabarti B, Dodd H, Murayama K, Stuijfzand S, Creswell C. Do clinically anxious children cluster according to their expression of factors that maintain child anxiety? J Affect Disord 2018; 229:469-476. [PMID: 29334641 PMCID: PMC5814677 DOI: 10.1016/j.jad.2017.12.078] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 12/08/2017] [Accepted: 12/31/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND Cognitive Behaviour Therapy (CBT) is an effective treatment for childhood anxiety disorders, yet a significant proportion of children do not benefit from it. CBT for child anxiety disorders typically includes a range of strategies that may not all be applicable for all affected children. This study explored whether there are distinct subgroups of children with anxiety disorders who are characterized by their responses to measures of the key mechanisms that are targeted in CBT (i.e. interpretation bias, perceived control, avoidance, physiological arousal, and social communication). METHODS 379 clinically anxious children (7-12 years) provided indices of threat interpretation, perceived control, expected negative emotions and avoidance and measures of heart rate recovery following a speech task. Parents also reported on their children's social communication difficulties using the Social Communication Questionnaire (SCQ). RESULTS Latent profile analysis identified three groups, reflecting (i) 'Typically anxious' (the majority of the sample and more likely to have Generalized anxiety disorder); (ii) 'social difficulties' (characterized by high SCQ and more likely to have social anxiety disorder and be male); (iii) 'Avoidant' (characterized by low threat interpretation but high avoidance and low perceived control). LIMITATIONS Some measures may have been influenced by confounding variables (e.g. physical variability in heart rate recovery). Sample characteristics of the group may limit the generalizability of the results. CONCLUSIONS Clinically anxious children appear to fall in to subgroups that might benefit from more targeted treatments that focus on specific maintenance factors. Treatment studies are now required to establish whether this approach would lead to more effective and efficient treatments.
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Affiliation(s)
- Samantha Pearcey
- School of Psychology and Clinical Language Sciences, University of Reading, PO Box 238, Reading RG6 6AL, United Kingdom.
| | - Anna Alkozei
- Department of Psychiatry, University of Arizona, 1501 N. Campbell Ave, Tucson, AZ 85721, United States
| | - Bhismadev Chakrabarti
- School of Psychology and Clinical Language Sciences, University of Reading, PO Box 238, Reading RG6 6AL, United Kingdom
| | - Helen Dodd
- School of Psychology and Clinical Language Sciences, University of Reading, PO Box 238, Reading RG6 6AL, United Kingdom
| | - Kou Murayama
- School of Psychology and Clinical Language Sciences, University of Reading, PO Box 238, Reading RG6 6AL, United Kingdom
| | - Suzannah Stuijfzand
- School of Psychology and Clinical Language Sciences, University of Reading, PO Box 238, Reading RG6 6AL, United Kingdom
| | - Cathy Creswell
- School of Psychology and Clinical Language Sciences, University of Reading, PO Box 238, Reading RG6 6AL, United Kingdom
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Lawrence PJ, Rooke SM, Creswell C. Review: Prevention of anxiety among at-risk children and adolescents - a systematic review and meta-analysis. Child Adolesc Ment Health 2017; 22:118-130. [PMID: 32680383 DOI: 10.1111/camh.12226] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/08/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Anxiety disorders are common, often start in childhood and run a chronic course. As such there is a need for effective prevention. METHODS We conducted a systematic review and meta-analyses of randomized, controlled trials to prevent the onset of anxiety disorders in 'at risk' young people. Diagnostic and symptom outcomes were examined. Putative moderators were tested as was publication bias. RESULTS We included 16 trials (2545 young people). Two trials reported diagnostic outcomes, and significant effects were found for these at end-of-programme (RR = .09, 95%CI = .02 to .16), 6- (RR = .17, 95%CI = .06 to .27) and 12-month (RR = .31, 95%CI .17 to .45) follow-ups. Based on 16 trials, improved anxiety symptoms were significant compared to nonattention controls only, with small effect sizes reported by young people at the end-of-programmes, 6- and 12-month follow-ups; and by parents at the end of the programmes and 12-, but not 6-, month follow-ups. There was no evidence of significant moderation or publication bias. CONCLUSIONS Fourteen studies included children and young people who presented with elevated anxiety symptoms, but anxiety disorder was not ruled out in the participants in these studies. Hence, these studies might be reporting results of mixed prevention/early intervention programmes. Prevention programmes that target developmental risk factors, not only disorder maintaining factors, appear most promising. The clinically meaningful impact of anxiety disorder prevention programmes remains unknown.
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Affiliation(s)
- Peter J Lawrence
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, RG6 6AL, UK
| | - Sally M Rooke
- Academic Unit of Psychology, University of Southampton, Southampton, UK
| | - Cathy Creswell
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, RG6 6AL, UK
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Evans R, Thirlwall K, Cooper P, Creswell C. Using symptom and interference questionnaires to identify recovery among children with anxiety disorders. Psychol Assess 2017; 29:835-843. [PMID: 27845527 PMCID: PMC5490389 DOI: 10.1037/pas0000375] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Revised: 06/29/2016] [Accepted: 06/30/2016] [Indexed: 01/31/2023]
Abstract
Questionnaires are widely used in routine clinical practice to assess treatment outcomes for children with anxiety disorders. This study was conducted to determine whether 2 widely used child and parent report questionnaires of child anxiety symptoms and interference (Spence Child Anxiety Scale [SCAS-C/P] and Child Anxiety Impact Scale [CAIS-C/P]) accurately identify recovery from common child anxiety disorder diagnoses as measured by a 'gold-standard' diagnostic interview. Three hundred thirty-seven children (7-12 years, 51% female) and their parents completed the ADIS-IV-C/P diagnostic interview and questionnaire measures (SCAS-C/P and CAIS-C/P) before (Time 1) and after (Time 2) treatment or wait-list. Time 2 parent reported interference (CAIS-P) was found to be a good predictor of absence of any diagnoses (area under the curve [AUC] = .81). In terms of specific diagnoses, Time 2 SCAS-C/P separation anxiety subscale (SCAS-C/P-SA) identified recovery from separation anxiety disorder well (SCAS-C-SA, AUC = .80; SCAS-P-SA, AUC = .82) as did the CAIS-P (AUC = .79). The CAIS-P also successfully identified recovery from social phobia (AUC = .78) and generalized anxiety disorder (AUC = .76). These AUC values were supported by moderate to good sensitivity (.70-.78) and specificity (.70-.73) at the best identified cut-off scores. None of the measures successfully identified recovery from specific phobia. The results suggest that questionnaire measures, particularly the CAIS-P, can be used to identify whether children have recovered from common anxiety disorders, with the exception of specific phobias. Cut-off scores have been identified that can guide the use of routine outcome measures in clinical practice. (PsycINFO Database Record
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Affiliation(s)
- Rachel Evans
- School of Psychology and Clinical Language Sciences, University of Reading
| | - Kerstin Thirlwall
- School of Psychology and Clinical Language Sciences, University of Reading
| | - Peter Cooper
- School of Psychology and Clinical Language Sciences, University of Reading
| | - Cathy Creswell
- School of Psychology and Clinical Language Sciences, University of Reading
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Creswell C, Waite P. Recent developments in the treatment of anxiety disorders in children and adolescents. EVIDENCE-BASED MENTAL HEALTH 2016; 19:65-8. [PMID: 27402874 PMCID: PMC10699454 DOI: 10.1136/eb-2016-102353] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 05/25/2016] [Accepted: 06/09/2016] [Indexed: 11/03/2022]
Abstract
Anxiety disorders are among the most common emotional difficulties experienced by children and young people. They cause significant disturbance to the lives of young people and their families and present a risk for lifelong psychological disturbance. Effective psychological (ie, cognitive-behaviour therapy (CBT)) and pharmacological interventions (eg, selective serotonin reuptake inhibitors (SSRIs)) have been established. However, the risk of adverse effects and unknown long-term effects of using SSRIs has led to recommendations that CBT is delivered as a first-line intervention. Recent innovations have included the development of low-intensity CBT programmes, delivered briefly via parents or online. These hold promise to increase access to psychological therapies for children and young people with these common and severe difficulties.
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Affiliation(s)
- Cathy Creswell
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, Berkshire, UK
| | - Polly Waite
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, Berkshire, UK
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Lundkvist-Houndoumadi I, Thastum M, Nielsen K. Parents' difficulties as co-therapists in CBT among non-responding youths with anxiety disorders: Parent and therapist experiences. Clin Child Psychol Psychiatry 2016; 21:477-90. [PMID: 26614573 DOI: 10.1177/1359104515615641] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
No increased effect has been associated with parent involvement in cognitive behavioral therapy (CBT) for youths with anxiety disorders. The purpose of this study was to explore parent and therapist experiences of CBT among non-responding youths with anxiety disorders, with a primary focus on parent involvement in therapy. Interpretative phenomenological analysis was applied to 24 sets of semi-structured interviews with families and therapists of anxiety-disordered youths who had not profited from CBT with parental inclusion. From the superordinate theme parents' difficulties acting as co-therapists, which emerged from the analyses, two master themes represented the perspectives of parents (difficulty working together with the youth and feeling unqualified, with limited resources), and two represented the perspectives of therapists (family dynamics stood in the way of progress and difficulty transferring control to parents). Parent and therapist experiences complemented each other, offering two different perspectives on parent difficulties as co-therapists. However, the two groups' views on their respective roles in therapy were in conflict. Parents wished to remain being "just the parents" and for the experts to take over, while therapists wished to act as facilitators transferring the control to parents. Clinical implications are drawn for parental involvement and enhancement of treatment outcomes for likely non-responders.
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Affiliation(s)
| | - Mikael Thastum
- Department of Psychology and Behavioural Sciences, Aarhus University, Denmark
| | - Klaus Nielsen
- Department of Psychology and Behavioural Sciences, Aarhus University, Denmark
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