Different Types and Acceptability of Psychotherapies for Acute Anxiety Disorders in Children and Adolescents

Zhou, Xinyu; Zhang, Yuqing; Furukawa, Toshi A; Cuijpers, Pim; Pu, Juncai; Weisz, John R.; Yang, Lining; Hetrick, Sarah; Giovane, Cinzia Del; Cohen, Doron; James, Anthony; Yuan, Shuai; Whittington, Craig; Jiang, Xiaofeng; Teng, Teng; Cipriani, Andrea; Xie, Peng

doi:10.1001/jamapsychiatry.2018.3070

Cited by 74 publications

(72 citation statements)

References 53 publications

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“…Regarding efficacy, the results suggested that, compared with the WL control condition, parent-only CBT is an effective treatment for reducing anxiety symptoms and relieving anxiety in children, leading to remission at the end of treatment. The findings in this pair-wise meta-analysis were consistent with a previously reported network meta-analysis [25]. The network meta-analysis included studies in which more than 20% of children took psychotropic drugs, and revealed that parent-only CBT led to better outcomes than WL control condition in children with various types of anxiety disorders.…”

Section: Discussionsupporting

confidence: 89%

“…Comparison of parent-only CBT with CBT involving parents revealed the same efficacy of the two treatments. According to previous studies [25,26], CBT involving parents was effective for treating child anxiety disorders. Particularly for early childhood anxiety, CBT involving parents is reported to be more beneficial for young children than for older children because of their limited language and cognitive competence [27].…”

Section: Discussionmentioning

confidence: 99%

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Efficacy and Acceptability of Parent-only Group Cognitive Behavioral Intervention for Treatment of Anxiety disorder in Children and Adolescents : A Meta-analysis of Randomized Controlled Trials

Yin

Teng

Tong³

et al. 2020

Preprint

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Background: Anxiety disorder is the most prevalent mental disorder among children and adolescents, causing significant psychosocial problems and physical health conditions. Cognitive behavioral therapy (CBT) is an effective treatment for anxiety disorder in children and adolescents. As a new type of CBT, parent-only CBT has some advantages. However, it remains unclear whether parent-only CBT interventions are effective for treating children and adolescents with anxiety disorder.Methods: In this study, we evaluated the efficacy and acceptability of parent-only cognitive behavioral therapy (CBT) for children and adolescents with anxiety disorder. We searched electronic databases, including PubMed, Cochrane Library, Embase, Web of Science, ProQuest, and PsycINFO from inception to June 2019. We included randomized controlled trials (RCTs) comparing parent-only CBT either with waitlist (WL), or CBT with parents in children and adolescents with anxiety disorder.Results: Finally, six RCTs with 407 participants were included in the meta-analyses. In terms of efficacy, pooled analyses indicated that parent-only CBT was significantly more effective than WL for reducing anxiety symptoms with SMD of −0.72 (95% CI −1.41 to −0.03, p = 0.04), and more remission rate with RR of 4.33 (37.96% vs. 6.85%, 95% CI 1.82 to 10.27, p = 0.0009) at post-treatment. And our analyses showed no evidence that parent-only CBT had significantly greater efficacy than CBT with parents with SMD of 0.21 (95% CI −0.09 to 0.50, p = 0.17). Acceptability in the parent-only CBT group was not significantly different to the WL group with RR of 0.92 (95% CI 0.52 to 1.62, p = 0.77), and was significantly worse than in the CBT with parents group with RR of 1.93 (95% CI 1.05 to 3.57, p = 0.03).Conclusions: Current evidence indicates that parent-only CBT can be an effective and acceptable intervention for treating children and adolescents with anxiety disorder.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Efficacy and Acceptability of Parent-only Group Cognitive Behavioral Intervention for Treatment of Anxiety disorder in Children and Adolescents : A Meta-analysis of Randomized Controlled Trials

Yin

Teng

Tong³

et al. 2020

Preprint

Self Cite

View full text Add to dashboard Cite

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“…Where previous reviews have considered outcomes in relation to parent involvement (e.g. Zhou, Zhang, Furukawa, Cuijpers et al 2019 ; Reynolds et al 2012 ), they have not focused specifically on adolescents or anxiety disorders. In reviews of treatment for younger children or across broad age ranges, there have been mixed findings for whether parental involvement improves outcome (Reynolds et al 2012 ; Thulin et al 2014 ); however, there is some indication that where parental involvement includes contingency management or transfer of control, this has a beneficial effect on child outcome at follow-up (Manassis et al 2014).…”

Section: Introductionmentioning

confidence: 99%

A Systematic Review of Parental Involvement in Cognitive Behavioural Therapy for Adolescent Anxiety Disorders

Cardy

Waite

Cocks

et al. 2020

Clin Child Fam Psychol Rev

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Anxiety disorders are common among adolescents and lead to poor long-term outcomes. Cognitive Behavioural Therapy (CBT) is an evidenced-based intervention for adolescent anxiety disorders, but little is known about whether and how parents should be involved. This systematic review evaluated how parents have been involved and associated treatment outcomes in studies of CBT for adolescent anxiety disorders. Electronic systematic searches were conducted in PsycINFO, Embase, CINAHL, Medline, AMED databases, to identify studies investigating CBT for adolescent anxiety disorder(s) that included parents in treatment. Twenty-three papers were identified. Parents were involved in treatment in a number of different ways: by attending separate parent sessions, joint parent–adolescent sessions, or both, or through provision of a workbook while attending some adolescent sessions. Content varied but was most typically aimed at the parent developing an understanding of core CBT components and skills to help them manage their adolescent’s anxiety and avoidance. Treatment outcomes indicate that CBT with parental involvement is an effective intervention for adolescent anxiety disorders; however, it is not possible to draw conclusions regarding whether parental involvement (generally or in any particular form) enhances treatment outcomes. Poor reporting and methodological issues also limit the conclusions. Further research is required to identify whether there are particular types of parental involvement in CBT that bring clinical benefits to adolescents with anxiety disorders generally, as well as in particular circumstances.

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“…Where studies focus specifically on adolescents, the majority of RCTs have involved young people with primary social anxiety disorder (e.g. 62% of adolescent studies in Zhou et al, ) and those with large effect sizes have tended to include young people identified through screening in schools and include sessions within and outside schools to practice social skills (Masia Warner, Fisher, Shrout, Rathor, & Klein, ; Masia‐Warner et al, ). Given these trials involve young people who are regularly attending school, it is unclear to what extent the findings will extend to those young people who experience high avoidance (and potentially symptom severity) which has led to difficulties attending school.…”

Section: Treatment: Psychological Interventionsmentioning

confidence: 99%

Practitioner Review: Anxiety disorders in children and young people – assessment and treatment

Creswell

Waite

Hudson

2020

Child Psychology Psychiatry

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Despite significant advancements in our knowledge of anxiety disorders in children and adolescents, they continue to be underrecognised and undertreated. It is critical that these disorders are taken seriously in children and young people as they are highly prevalent, have a negative impact on educational, social and health functioning, create a risk of ongoing anxiety and other mental health disorders across the life span and are associated with substantial economic burden. Yet very few children with anxiety disorders access evidence-based treatments, and there is an urgent need for widespread implementation of effective interventions. This review aimed to provide an overview of recent research developments that will be relevant to clinicians and policymakers, particularly focusing on the development and maintenance of child anxiety disorders and considerations for assessment and treatment. Given the critical need to increase access to effective support, we hope this review will contribute to driving forward a step change in treatment delivery for children and young people with anxiety disorders and their families. Key practitioner messages:Assessment of anxiety disorders should routinely involve valid and reliable interview and questionnaire measures of anxiety disorders and other common comorbid problems.Cognitive behaviour therapy is effective for treating anxiety disorders in children and young people. There is currently insufficient evidence for the effectiveness of any other psychological treatment. There is evidence that SSRIs are effective in the short-medium term, but there is a lack of longer-term evaluation.Few children who could benefit receive treatment for anxiety disorders. Brief guided interventions that can be delivered by nonspecialists are effective for some preadolescent children and provide a means to increase access to psychological interventions, potentially within a stepped care model, but less is known about their effectiveness for adolescents. Anxiety disorders in children and young people 637 Areas for future research:Experimental studies to elucidate (cognitive, behavioural, environmental) maintenance mechanisms of anxiety disorders and how they vary across childhood and adolescence and in particular contexts.Sufficiently large treatment studies to examine predictors, mediators and moderators of treatment to help optimise treatment outcomes and support improvements in personalised care.Use of technology to promote engagement, access, integrity, efficiency and effectiveness of treatments. Comparisons of different treatment approaches that are fully powered to detect meaningful clinical differences, with appropriate control conditions (e.g. including placebo where appropriate).Health economic evaluations to enable health services to increase access by offering the most efficient treatment approaches. Implementation research to maximise application and integrity of evidence-based treatments in routine clinical practice.

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Different Types and Acceptability of Psychotherapies for Acute Anxiety Disorders in Children and Adolescents

Cited by 74 publications

References 53 publications

Efficacy and Acceptability of Parent-only Group Cognitive Behavioral Intervention for Treatment of Anxiety disorder in Children and Adolescents : A Meta-analysis of Randomized Controlled Trials

Efficacy and Acceptability of Parent-only Group Cognitive Behavioral Intervention for Treatment of Anxiety disorder in Children and Adolescents : A Meta-analysis of Randomized Controlled Trials

A Systematic Review of Parental Involvement in Cognitive Behavioural Therapy for Adolescent Anxiety Disorders

Practitioner Review: Anxiety disorders in children and young people – assessment and treatment

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