Cognitive behavioural therapy for anxiety disorders in children and adolescents

Abstract

BackgroundPrevious Cochrane Reviews have shown that cognitive behavioural therapy (CBT) is e ective in treating childhood anxiety disorders. However, questions remain regarding the following: up-to-date evidence of the relative e icacy and acceptability of CBT compared to waiting lists/no treatment, treatment as usual, attention controls, and alternative treatments; benefits across a range of outcomes; longerterm e ects; outcomes for di erent delivery formats; and amongst children with autism spectrum disorders (ASD) and children with intellectual impairments. ObjectivesTo examine the e ect of CBT for childhood anxiety disorders, in comparison with waitlist/no treatment, treatment as usual (TAU), attention control, alternative treatment, and medication. Search methodsWe 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 criteriaWe 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 e ects, and longer-term e ects. Data collection and analysisWe used standard methodological procedures as recommended by Cochrane. We used GRADE to assess the quality of the evidence. Main resultsWe included 87 studies and 5964 participants in quantitative analyses. Cognitive behavioural therapy for anxiety disorders in children and adolescents (Review)

Genetic variation in the endocannabinoid system and response to Cognitive Behavior Therapy for child anxiety disorders

“…Clinical outcomes in the full sample were comparable to previously reported estimates [Hudson et al, , ; James et al, ]. Following treatment, 58% of the sample was free of their primary anxiety disorder diagnosis with this rate rising to 67% by follow‐up.…”

“…Childhood anxiety disorders are very common [Kessler et al, ] and are associated with a wide range of impairments [Kim‐Cohen et al, ; Erath et al, ; Asendorpf et al, ]. Response to Cognitive Behavior Therapy (CBT) varies substantially between patients [James et al, ]. Identifying predictors of response is important given the potential for clinicians to identify children and adolescents at risk for poorer outcomes before treatment begins and to help inform the development of more efficacious therapies.…”

Novel four‐session treatment intervention for anxiety and high‐functioning autism: A single case report for Externalizing Metaphors Therapy

“…While this body of work suggests that CBT shows moderate effect sizes for co‐occurring anxiety and ASD in youth, there remains considerable heterogeneity in the effects between studies (Kreslins, Robertson, & Melville, ; Reynolds, Wilson, Austin, & Hooper, ; Ung, Selles, Small, & Storch, ), with estimates ranging from large (e.g., Chalfant et al, ) to small (e.g., Sofronoff, Attwood, & Hinton, ), and at least one documented instance of increased anxiety over treatment (as rated by parents, but not clinicians; Ooi et al, ). A Cochrane review further found that while CBT was effective for reducing anxiety diagnoses in youth with ASD when compared with waitlist controls, no differences were found when comparing CBT to active control treatments or treatment as usual (James, James, Cowdrey, Soler, & Choke, ), which aligns with other recent work showing no differences between CBT and person‐centered therapy for youth with co‐occurring ASD and anxiety (Murphy et al, ).…”

Father's and mother's beliefs about children's anxiety

“…Furthermore, in spite of the empirical evidence of cognitive‐behavioral therapy effectiveness for children's anxiety problems (e.g., Cartwright‐Hatton, Roberts, Chitsabesan, Fothergill, & Harrington, ; James, James, Cowdrey, Soler & Choke., ), many parents do not seek professional help. Some predictors have been studied regarding parental recognition of their child's emotional or behavioral problems (e.g., their perception of the problem as nonsevere: Angold et al, ; Lyneham & Rapee, ) and help seeking (e.g., child's age, the amount of distress or burden parents experience in raising their child, and the existence of related medical or school problems: for a review, see Zwaanswijk, Verhaak, Bensing, van der Ende, & Verhulst, 2003).…”