Symptom‐specific effects of cognitive‐behavioral therapy, sertraline, and their combination in a large randomized controlled trial of pediatric anxiety disorders

Abstract

Background Pediatric anxiety disorders are highly prevalent and associated with significant functional disabilities and lifelong morbidity. Cognitive‐behavioral therapy (CBT), sertraline, and their combination are effective treatments, but little is known about how these treatments exert their effects. Methods Using network intervention analysis (NIA), we analyzed data from the largest randomized controlled treatment trial of pediatric anxiety disorders (Child/Adolescent Anxiety Multimodal Study, NCT00052078, http://clinicaltrials.gov/ct2/show/NCT00052078) and outlined the causal symptom domain‐specific effects of CBT, sertraline, and their combination over the course of the 12‐week treatment while taking into account both specificity and overlap between symptom domains. Results All active treatments produced positive effects with the most pronounced and consistent effects emerging in relation to psychological distress, family interference, and avoidance. Psychological distress was consistently the most and physical symptoms the least central symptom domain in the disorder network. Conclusions All active treatments showed beneficial effects when compared to placebo, and NIA identified that these effects were exerted similarly across treatments and primarily through a reduction of psychological distress, family interference, and avoidance. CBT and sertraline may have differential mechanisms of action in relation to psychological distress. Given the lack of causal effects on interference outside family and physical symptoms, interventions tailored to target these domains may aid in the building of more effective treatments. Psychological distress and avoidance should remain key treatment focuses because of their central roles in the disorder network. The findings inform and promote developing more effective interventions.

Mechanisms of cognitive-behavioral therapy effects on symptoms of body dysmorphic disorder: a network intervention analysis

“…Network intervention analysis allows for inspection of treatment-induced changes in specific symptoms over time and characterizes direct v. indirect treatment effects (Blanken et al, 2019). First pioneered by Blanken and colleagues to examine the impact of CBT-I on insomnia and depression (compared to no treatment), this method has since been used in four studies of treatments for pediatric anxiety (Cervin et al, 2020) and depression (Boschloo et al, 2019; Curtiss et al, 2021; Mullarkey, Stein, Pearson, & Beevers, 2020). In the current report, networks were constructed for each assessment point.…”

Pediatrician-friendly perspectives on cognitive behavioral therapy for anxious youth: Current status and clinical implications for the next normal

“…CBT is equally as effective as SSRIs but is associated with less adverse side effects[ 68 , 77 , 79 ]. Psychological distress characterized by anxiogenic cognitions and behavioral avoidance are apparently the most productive targets for intervention[ 2 ]. Perhaps most pivotally, the exposure component to treatment is essential to distinguish between more and less effective CBT as well as differentiate CBT from other systems of psychotherapy[ 8 , 17 , 41 - 51 ].…”

Network intervention analysis to assess the trajectory of change and treatment effects associated with the use of online guided self‐help for anorexia nervosa

“…NIA also provides novel outcomes in comparison to traditional analyses, which usually employ sum scores as index of disorder severity or binary classifications (ie, response vs no response). The application of NIA on Randomized Control Trial (RCT) findings makes possible to investigate the extent to which treatments differentially affect the same symptoms identifying the temporal patterns of these effects (Cervin et al, 2020). The aim of this study was to identify the mechanisms of clinical change promoted by treatment as usual (TAU) enhanced by RecoveryMANTRA, a short guided self‐management intervention that targets several putative maintaining factors of the illness (eating disorder psychopathology, emotional sensitivity, cognitive style and social emotional functioning), compared to TAU alone, at 6 weeks (end of treatment), 6 months and 12 months follow‐up.…”