Can less be more? Open trial of a stepped care approach for child and adolescent anxiety disorders

Abstract

This open trial presents a stepped care treatment approach for youths with anxiety disorders. In Step 1, 124 youths (65 girls; M age=9.7 years) participated in a low intensity computer administered attention bias modification (ABM) protocol. Statistically significant reductions in youth anxiety severity were found following Step 1. Youths and parents were then given the option to not continue with further treatment or step up to a higher intensity cognitive behavioral therapy (CBT) protocol (Step 2). Of 112 youths who completed Step 1, 67 (59.8%) discontinued treatment and 45 (40.2%) stepped up. Co-occurring ADHD and higher anxiety severity at baseline were significantly associated with the decision to step up. Of those youths who completed Step 2, additional statistically significant reductions in youth anxiety severity were found. Across the entire protocol, 68.6% of youths were rated as either very much improved or much improved on the Clinical Global Impressions-Improvement scale. In a hypothetical comparison in which all youths received CBT alone, the stepped care protocol resulted in approximately 50% less time in treatment sessions. These findings support the promise of initiating youth anxiety disorder treatment with low intensity treatment and then stepping up to higher intensity treatment as needed.

Long-term outcomes of internet-delivered cognitive behaviour therapy for paediatric anxiety disorders: towards a stepped care model of health care delivery

“…By the end of the 12MFU, these patients had improved as much as those who initially responded to ICBT. These results are in line with two other trials naturalistically investigating the effects of additional CBT for children with anxiety disorders who did not respond sufficiently after first receiving parental-guided CBT [15] or attention bias modification training [14].…”

“…ICBT is often quoted as a potential early intervention in the context of a stepped-care model [11], where patients are first offered a low-intensity intervention, reserving higher intensity treatments to more complex cases or to those who fail to benefit sufficiently [12]. Though stepped-care approaches may intuitively seem like an ideal model for psychiatric service delivery, evidence for their feasibility in real-world settings is scarce [12][13][14][15].…”

Predicting patterns of service utilization within children’s mental health agencies

“…This would be the Acute, Intensive, and Brief Episodic patterns in our sample, for whom the clinical characteristics at intake did not differ markedly. In stepped-care models [83], children first receive a low-intensity treatment (e.g., self-help CBT via internet) and if this treatment is not effective, more intensive and/or additional treatments are added (e.g., CBT delivered in-person, medication; [84, 85]).…”

Parent-led, stepped-care cognitive-behavioral therapy for youth with autism and co-occurring anxiety: study rationale and method

“…Stepped-care trials for childhood anxiety [38][39][40] and PTSD 41 have also consistently yielded favorable findings. Stepped-care interventions provide an efficient allocation of resources by providing a set number of sessions before the child is reevaluated and ''stepped up'' if they require additional care (versus providing a set number of sessions to all children regardless of clinical need).…”