Impact of Psychotherapy for Children and Adolescents with Anxiety Disorders on Global and Domain-Specific Functioning: A Systematic Review and Meta-analysis

Abstract

A substantial empirical base supports the use of psychotherapy to alleviate anxiety symptoms and diagnoses in children and adolescents. However, focusing only on symptom or diagnostic reduction provides an incomplete picture of clinically meaningful efficacy given that anxiety disorders in this age group are integrally associated with problems in functioning. A systematic review and meta-analysis (N studies = 40, N participants = 3094) evaluating the impacts of psychotherapy for anxiety was conducted on the following outcomes: global functioning, social functioning, academic functioning, and school attendance. Randomised controlled trials with a passive control condition, a child and/or adolescent sample (7–17 years) with a primary anxiety diagnosis, and receiving anxiety-focused psychotherapy were eligible for inclusion if they reported suitable outcome data. Results from the meta-analysis indicated that from pre- to post-treatment, psychotherapy led to significant improvements in global functioning according to clinician (d = 1.55), parent (d = 0.67), and child (d = 0.31) reports and on social functioning according to parent (d = 0.51), but not child (d = 0.31) reports. The qualitative review provided preliminary support psychotherapy’s efficacy in increasing family functioning and school attendance, but not so much in enhancing academic performance. These results indicate that psychotherapy improves daily functioning in anxious children and adolescents. The study also highlighted the limited attention paid to measures of functioning in the empirical literature on treatment of childhood anxiety.Trial Registry: This study is registered with PROSPERO under the identification number CRD42021246565.

Short Research Article: Changes in life functioning in a self‐help, online program for child and adolescent anxiety

“…In contrast to Dickson et al. 's (2022) findings, young people did not demonstrate significant changes in life interference in the early stages of programme participation (from registration to Session 4). In fact, both children and adolescents in the low completer group demonstrated an increase in AH interference, highlighting a potential barrier to continued participation for some young people.…”

“…Further, the hypothesis that anxiety symptom improvements would be positively associated with overall reductions in life interference was supported for both AH and OH interference, a finding that aligns with Dickson et al. (2022), who found evidence that anxiety treatment improves daily functioning in young people. However, although anxiety symptoms were found to reduce immediately and continued or were maintained throughout programme participation, this was not the case for life interference.…”

“…Changes in life functioning in self-help (Dickson et al, 2022). This study provides further insight into the relationship between changes in anxiety symptoms and changes in life interferences as they relate to both changes in anxiety symptoms and the level of programme completion.…”

“…This study examined changes in anxiety symptoms and life interference in a sample of young people participating in the BRAVE Self‐Help iCBT intervention. To date, researchers have primarily focused on the assessment of anxiety symptoms when examining the efficacy of child and adolescent anxiety treatments, such as iCBT (Dickson et al., 2022). This study provides further insight into the relationship between changes in anxiety symptoms and changes in life interferences as they relate to both changes in anxiety symptoms and the level of programme completion.…”

“…A recent systematic review and meta‐analysis found that psychotherapy led to significant improvements in global and social functioning, specifically supporting its efficacy in increasing both family functioning and school attendance. However, the impact of iCBT on life functioning has yet to be examined (Dickson, Kuhnert, Lavell, & Rapee, 2022).…”