Brief, Non-Pharmacological, Interventions for Pediatric Anxiety: Meta-Analysis and Evidence Base Status

Abstract

There is a need to reinvent evidence-based interventions (EBIs) for pediatric anxiety problems to better address the demands of real-word service delivery settings and achieve public health impact. The time-and resource-intensive nature of most EBIs for youth anxiety has frequently been noted as a barrier to the utilization of EBIs in community settings, leading to increased attention towards exploring the viability of briefer, more accessible protocols. Principally, this research reports between-group effect sizes from brief-interventions targeting pediatric anxiety and classifies each as wellestablished, probably efficacious, possibly efficacious, experimental, or questionable. brief interventions yielded an overall mean effect size of 0.19 on pediatric anxiety outcomes from pre to post. Effect sizes varied significantly by level of intervention: Pre to post-intervention effects were strongest for brief-treatments (0.35), followed by brieftargeted prevention (0.22), and weakest for brief-universal prevention (0.09). No participant or other intervention characteristic emerged as significant moderators of effect sizes. In terms of standard of evidence, one brief intervention is well-established, and five are probably efficacious, with most drawing on cognitive and behavioral change procedures and/or family systems models. At this juncture, the minimal intervention needed for clinical change in pediatric anxiety points to in-vivo exposures for specific phobias (~3 hours), cognitive-behavioral therapy (CBT) with social skills training (~3 hours), and CBT based parent training (~6 hours, eight digital modules with clinician support). This research concludes with a discussion on limitations to available brief EBIs, practice guidelines, and future research needed to capitalize on the viability of briefer protocols in enhancing access to, and impact of, evidence-based care in the real-world.

Economic Evaluations of Mental Health Programs for Children and Adolescents in the United States: A Systematic Review

“…Such results are in sharp contrast to the proliferation of novel, potentially low cost, as well as cost-effective intervention options now available to youths, providers, and families. Such (2003-present;Bennett et al, 2019;Firth, Torous, Nicholas, Carney, Pratap, et al, 2017;Lattie et al, 2019;Schleider & Weisz, 2017;Stoll et al, 2020). Similarly, the noted reviews and meta-analyses of non-face to face and low-intensity interventions examined efficacy and effectiveness, but did not examine costs or the relationship between costs and effectiveness.…”

Retiring, Rethinking, and Reconstructing the Norm of Once-Weekly Psychotherapy

“…Clearly, cookie-cutter treatment formats are unnecessary for meaningful therapeutic change. Indeed, large-scale trials and systematic reviews of treatments for anxiety disorders, depression, and behavior problems indicate that non-weekly interventions—from self-guided supports to brief, one-session treatments to concentrated, week-long interventions—can yield benefits approximately equivalent to once-weekly evidence-based psychotherapy, both for youths and adults (Beevers et al 2017 ; Öst and Ollendick 2017 ; Schleider et al 2020 ; Stoll et al 2020 ; Thompson-Hollands et al 2019 ).…”

Retiring, Rethinking, and Reconstructing the Norm of Once-Weekly Psychotherapy

“…Clearly, cookie-cutter treatment formats are unnecessary for meaningful therapeutic change. Indeed, large-scale trials and systematic reviews of treatments for anxiety disorders, depression, and behavior problems indicate that non-weekly interventions-from self-guided supports to brief, one-session treatments to concentrated, week-long interventions-can yield benefits approximately equivalent to once-weekly evidence-based psychotherapy, both for youths and adults (Beevers et al, 2017;Öst & Ollendick, 2017;Stoll et al, 2020;Thompson-Hollands et al, 2019).…”