Introduction
Method
Search Strategy
Eligibility Criteria
Data Collection
Quality Appraisal
Data Synthesis
Authors, (year) | Study design | Participants: N; gender; age range (mean, SD), ethnicity (%) | Primary diagnosis | Intervention: name; number, duration and frequency of adolescent sessions | Control condition: name; number, duration and frequency of adolescent sessions | Diagnostic measure and primary outcome (where stated)a | Remission of primary diagnosis and primary outcome (where stated)a | Reported adolescent attrition; findings | Quality rating score | |
---|---|---|---|---|---|---|---|---|---|---|
Joint parent–adolescent sessions | ||||||||||
Albano et al. (1995) | Case series | 5; 2 female, 3 male; 13–17 (14.4); not specified | Social phobia | CBGT-A; 16, 1.5 h sessions over three months | None | ADIS-C/P | Post-treatment: not provided; 3-month follow-up: 80%; 12-month follow-up: 100% | Yes; 0% | 16 | |
Christon et al. (2012) | Case study | 1; female; 15; Latina | Selective mutism and social phobia | MATCH; 60, unspecified, 21-months | None | K-SADS-PL | Selective mutism: post-treatment: 100%; no follow-up time-point. Social phobia: post-treatment: not reported; no follow-up time-point | Yes; 0% | 13 | |
Elkins et al. (2016) | RCT | 54; 33 female, 21 male; 11–17 (15.29, SD 1.68); Caucasian/Non-Hispanic (86.8%) remainder unspecified | Panic disorder with (n = 53) or without (n = 1) agoraphobia | Intensive PCT-A; 8 consecutive days. Fourth and fifth days were full-day sessions (6–8 h). Treatment included 4 weekly 30-min telephone calls following the eighth day of treatment | Wait list control; 6-weeks | PDSS-C | No pre- to post/follow-up data for remission or symptom severity. PCT-A group showed significantly greater reductions in panic severity at 6-weeks than waitlist control group (p < 0.01) (not specified if treatment completers/ITT) | No | 18 | |
Heard et al. (1992) | Case series (multiple baseline design) | 3; 3 females; 12–15 (13.33); not specified | Specific phobia | CBT; number unspecified, 1.5-h sessions over 3 months | None | FSSC-R | No pre- to post/follow-up data for remission. FSSC-R total scores decreased for all participants from pre- to post- to 3-month follow-up and were all in ‘non-clinical’ range (however, only of the 3 participants were in ‘clinical’ range pre-treatment) | Yes; 0% | 15 | |
Hoffman and Mattis (2000) | Case studies | 2; 1 female, 1 male; 13 (13); not specified | Panic disorder | PCT-A; 11, 1-h, weekly | None | RCMAS | No pre- to post/follow-up data for remission. RCMAS scores moved from ‘elevated’ to within the normal range post-treatment. No follow-up data provided | Yes; 0% | 13 | |
Leyfer et al. (2018) | Pilot RCT | 24; not specified; 12–17 (14.5, SD 1.77); Non-Hispanic White (95.8%), African American (4.2%) | Panic disorder with agoraphobia | Intensive PCT-A + DCS; 8 consecutive days of 2–6-h treatment each day | Intensive PCT-A + placebo; 8 consecutive days of 2–6-h treatment each day | ADIS-C/P | Post-treatment remission (treatment completers): 66.7% CBT + DCS group, 90% CBT + placebo group (differences not significant, p = .32). 3-month follow-up remission (treatment completers): 83.3% CBT + DCS group, 90% CBT + placebo group (differences not significant, p = 1.0) | Yes; 8.33% (CBT + DCS: 16.67%, CBT + placebo: 0%) dropped out during treatment | 25 | |
Ollendick (1995) | Case series (multiple baseline design) | 4; 3 female, 1 male; 13–17 (15); Caucasian (100%) | Panic disorder with agoraphobia | CBT for panic with agoraphobia; 10–12 (+ 2 booster sessions in following month), unspecified, weekly | None | ADIS-C/P | Post-treatment remission: 100%; 6-month follow-up remission: 100% | Yes; 0% | 16 | |
Pincus et al. (2010) | RCT | 26; 19 females, 6 males; 14–17 (15.75, SD 1.10); Caucasian (100%) | Panic disorder with agoraphobia | PCT-A; 11, 50-min weekly sessions, over a 12-week period (additional week between session 11 and 12) | Self-monitoring group; 20–30-min sessions, biweekly, over 8 weeks, to monitor panic and mood symptoms | ADIS-C/P (CSR) | Remission data not provided. PCT-A group (ITT) showed significantly greater reductions in CSR scores than control group (p < .01, d = 1.09). PCT-A (combined sampleb) CSR effect sizes pre- to post-treatment were large: d = 2.17. At follow-up CSR scores continued to decrease from post-treatment to 3-month follow-up (p < .01) and ‘did not change’ from 3- to 6-month follow-up. (not specified if treatment completers/ITT) | Yes; 12% (PCT-A: 12% dropped out of treatment, control: 0%) | 20 | |
Separate parent sessions | ||||||||||
Anderson et al. (1998) | Case study | 1; male; 13; not specified | Social phobia and adjustment disorder with anxiety | CBT with parent and school involvement; 7, 3 weeks, unspecified | None | ADIS-C/P | Post-treatment: 100% remission. 5-month follow-up: 100% remission | Yes; 0% | 11 | |
Baer and Garland (2005) | RCT | 12; 7 females, 5 males; 13–18 (15.5); not specified | Social phobia | Modification of SET-C; 12 1.5-h, weekly group sessions | Waitlist: details not specified | ADIS-C | Post-treatment remission (treatment completers): treatment group: 64%, control group 0%. Treatment group improved significantly compared to the waitlist control (p = 0.03; d = 1.63). No follow-up data provided | Yes; 8.33% in SET-C dropped out of treatment | 18 | |
Legerstee et al. (2008) | RCT | 51; 29 females, 22 males; 12–16 (13.9, SD 1.1; not specified | SAD, GAD, social phobia, specific phobia, panic disorder, agoraphobia | Individual CBT using the Dutch translation of FRIENDS program; 10 unspecified, weekly | (adolescents in the trial only received individual CBT, whereas children, who were analysed separately, were randomised to either group or individual CBT) | ADIS-C/P | Post-treatment remission (ITT): 64%. Maternal (but not paternal) lifetime anxiety disorders were a significant predictor of remission (p = 0.02, OR 6.36, 95% CI 1.30–31.11). No follow-up data were provided | No | 20 | |
Masia-Warner et al. (2005) | RCT | 42; 26 females, 9 males; 14–17 (14.8, SD 0.81); Caucasian (82.9%), African American (8.6%), Asian American (2.9%), Latin American (2.9%), Other (2.9%) | Social anxiety disorder | SASS; 12 40-min weekly group school sessions, 2 15-min individual meetings, 4 90-min social events, 2 monthly group booster sessions, over 3 months | Waitlist: details not specified | ADIS-C/P LSAS-CA | Post-treatment remission (treatment completers): SASS group 67%, control group 6%. SASS led to significantly greater CSR reductions (p < 0.0001, d = 2.4) than the control group. 9-month follow-up remission (treatment completers): SASS group 72% (no control comparison) | Yes; 16.67% in SASS dropped out of treatment | 19 | |
Masia-Warner et al. (2007) | RCT | 36; 30 females, 6 males; 14–16 (15.1, SD 0.6); Caucasian (72.2%), African-American (5.6%), Hispanic (16.7%), Other (5.6%) | Social anxiety disorder | SASS; 12 40-min group sessions, 2 15-min individual sessions, 4 90-min social events, 2 booster sessions | Educational-Supportive Group Function (ESGF); format and therapist contact identical to SASS | ADIS-C/P (CSR) CGI | Post-treatment remission (treatment completers): SASS group 58.8%, control group 0%. SASS led to significantly more adolescents in remission (p < .001) than the control group. 6-month follow-up remission (treatment completers): SASS 73.3%, control 6.7%; difference between groups was significant (p < .01) | Yes; 11.11% (SASS group: 10.52%, ESGF: 11.76%) dropped out of treatment | 22 | |
Masia-Warner et al. (2016) | RCT | 138; 94 female, 44 male; 14–17 (15.42, SD 0.81); White (72%) | Social anxiety disorder | C-SASS and P-SASS; 12 group sessions, 2 15-min individual sessions, 4 90-min social events, two group booster sessions | Skills for Life (SFL); non-specific counselling program, details unspecified | ADIS-C/P (CSR) | Post-treatment remission (ITT): C-SASS 20.9%, P-SASS 30.8%, SFL 7.9%. 5-month follow-up remission (ITT): C- SASS: 39.5%, P-SASS 33.3%, SFL 13.2%. No significant differences between C-SASS and P-CASS on any outcomes. SASS had significantly lower CSR scores than controls at post-treatment (C-SASS d = 0.69, P-SASS d = 0.67) and 5-month follow-up (C-SASS d = 0.93, P-SASS d = 0.83) | Yes; 13.04% (C-SASS: 6.52%, P-SASS: 17.02%, SFL: 11.63%) dropped out of treatment | 21 | |
Nordh et al. (2017) | Case series | 30; 25 females, 5 males; 13–17 (15, SD 1.22); not specified | Social anxiety disorder | Internet-delivered CBT; 12 weeks, 9 remote therapist-guided internet-delivered sessions and 3 2-h group exposure sessions on weeks 4, 6, 10 | None | MINI KID ADIS-C Social anxiety disorder section, CGI-S (specified as primary) | Post-treatment remission: 47% (d = 1.17). 6-month follow-up: 57% (d = 0.22). (86.67% of sample assessed, not specified if treatment completers). CGI-S (ITT) decreased pre- to post-, p < .001, d = 1.17, and from post- to 6-month follow-up, p < .05, d = 0.22 | Yes; 36.67% completed 7–9 internet sessions and 2/3 attended 2–3 group sessions | 22 | |
Spence et al. (2008) | Case study | 1; female; 17; Caucasian | Social phobia | BRAVE-for teenagers ONLINE; 10, 1-h, weekly, with 2 booster sessions | None | ADIS-C/P CGAS | Post-treatment remission: 100%. Follow-up data not reported | Yes; 0% | 13 | |
Spence et al. (2011) | RCT | 115; 68 female, 47 male; 12–18 (13.98, SD 1.63); not specified | GAD (48%), social phobia (35%), SAD (13%), specific phobia (4%) | BRAVE-for teenagers ONLINE (NET), 10, 1-h, weekly, 2 booster sessions at 1- and 3-months post-treatment BRAVE-CLINIC (CLIN), 10, face-to-face, 1-h, weekly, 2 booster sessions at 1- and 3-months post-treatment | Waitlist: 12 weeks with no contact | ADIS-C/P CGAS | Remission 12-weeks post-treatment (ITT): NET: 34.1% CLIN 29.5%: control: 3.7%. 12-month follow-up remission (ITT): NET 68.2%, CLIN 68.2% (no control data). No significant differences at 12-month follow-up between NET and CLIN (p = 1.00) | Yes; 12-month follow-up 43% NET and 21% CLIN adolescents did not complete all 10 sessions. This difference was statistically significant (p = .02) | 22 | |
Waite et al. (2019) | RCT | 60; 39 female, 21 male; 13–18 (14.7, SD 1.34); White British (91.7%), remainder of sample unspecified | Social anxiety disorder, GAD, specific phobia, SAD, panic with or without agoraphobia, agoraphobia | BRAVE-for teenagers ONLINE; 10, 1-h, weekly Two arms: Adolescent and parent (ADOL + PARENT) Adolescent only (ADOL-ONLY) | Waitlist: 10 weeks with no contact | ADIS-C/P (remission specified as primary) | CBT versus waitlist: Post-treatment remission (ITT): intervention 40.0%, control 33.3% (p = 0.59. Difference not statistically significant (p = 0.12, OR 1.33, 95% CI 0.46–3.82). 6-month follow-up remission (ITT): post-CBT 51.7% (no control data). Significant improvements from post-CBT to 6-month follow-up (p = .04, OR = 13.72, 95% CI 0.77–12.60) Parent involvement: Post-CBT remission (ITT): ADOL + PAR 33.3%, ADOL-ONLY 40.0%. Difference not significant (p = 0.59, OR 0.75, 95% CI 0.26–2.15). 6-month follow-up remission (ITT): ADOL + PAR 53.3%, ADOL-ONLY 50.0%. Difference not significant (p = 0.80, OR 1.14, 95% CI 0.42–3.15). (all analyses ITT) | Yes; 20.7% did not complete all 10 sessions 21.43% ADOL + PAR and 13.33% ADOL-ONLY did not complete post-CBT assessment | 25 | |
Separate parent sessions and joint parent–adolescent sessions | ||||||||||
Kendall and Barmish (2007) | Case study | 1; male; 13; Caucasian | Social phobia | Coping Cat; 14 unspecified duration, weekly | None | ADIS-C/P | Post-treatment remission: 100%. No follow-up data reported | Yes; 0% | 10 | |
Siqueland et al. (2005) | Phase I Case series | 8; 4 females, 4 males; 14–17 (15.5); Caucasian (87.5%), Hispanic (12.5%) | GAD (75%), social phobia (25%) | CBT-ABFT; 16; unspecified duration and frequency | None | BAI | Post-treatment remission data not reported. 88% of BAI scores in ‘non-clinical’ range (≤ 18) | Yes; 0% | 18 | |
Phase II RCT | 11; 3 females, 8 males; 12–17 (14.9, SD 1.8); Caucasian (90.9%), African American (9.1%) | GAD (90.9%), SAD (9.1%) | CBT-ABFT; 16; unspecified duration and frequency | CBT modified for adolescents; 16; unspecified duration and frequency | ADIS-C/P BAI CRPBI | Post-treatment remission (all participants): CBT-ABFT 40%, CBT 67%. 6-month follow-up remission: CBT-ABFT 80%, CBT 100% | Yes; CBT-ABFT 9.09%, CBT 0% did not complete 12/16 sessions (‘adequate dose’) | 17 | ||
Workbook | ||||||||||
Stjerneklar et al. (2018) | Case series (multiple baseline design) | 6; 3 females, 3 males; 13–17 (15); not specified | GAD, social phobia, specific phobia | Internet-based Chilled Out; 12-weeks to complete 8 online modules, 30-min each | None | ADIS-C/P | Post-treatment remission (all participants) 33.33%. 3-month follow-up data not reported | Yes; 16.67% dropped out of treatment | 16 | |
Wuthrich et al. (2012) | RCT | 24; 16 females, 8 males; 14–17 (15.17, SD 1.11); Australian (77.3%), Asian / Asian Australian (4.5%), European/European Australian (13.6%), Other (4.5%) | GAD, social phobia, SAD, specific phobia, anxiety disorder not otherwise specified | Cool Teens; 8 therapy modules of 30-min, duration of treatment not specified | Waitlist: 12 weeks no contact | ADIS-C/P | Post-treatment remission (treatment completers): Cool Teens 41%; control 0%. 3-month follow-up: Cool Teens 26% (no control group data) | Yes; 8.33% dropped out of treatment | 21 | |
Format not specified | ||||||||||
Leigh and Clark (2016) | Case series | 5; 4 females, 1 male; 11–17 (14.8); not specified | Social anxiety disorder | CT-SAD; 14, 1.5 h, with follow-up at 1, 2, 3 months post-treatment | None | ADIS-C/P LSAS (specified as primary) | Post-treatment: 100% remission; no follow-up remission data. LSAS showed symptom severity improved from pre- to post and post- to 2-3-month follow-up | Yes; 0% | 16 |
Results
Study Characteristics
Quality Appraisal
Research Question 1: In What Ways Have Parents Been Involved in CBT for Adolescent Anxiety Disorders?
Authors (year) | Parent(s) relationship to child | Nature of parental involvement | Number (duration) of each parent session | Treatment components involving parents | Parent satisfaction with treatment | |||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Psycho-education | Relaxation | Problem solving | Cognitive restructuring | Contingency Management | Supporting graded exposure | Addressing parental beliefs and behaviours | Relapse prevention | |||||
Joint parent–adolescent sessions | ||||||||||||
Albano et al. (1995) | Not specified | Joined adolescent sessions 1, 2, 8, 15 | 4 (90-min) | X | – | – | – | – | X | X | – | Not reported |
Christon et al. (2012) | Mother | Majority of sessions included 10- to 15-min parent component or review of treatment | Not specified | – | – | – | – | X | X | X | – | Not reported |
Elkins et al. (2016) | Not specified | Unclear involvement in sessions | Not specified | – | – | – | – | – | X | – | – | Not reported |
Heard et al. (1992) | Mothers and fathers | Joined adolescent sessions | Weekly (90-min) for 3-months | – | – | – | – | X | X | – | – | Not reported |
Hoffman and Mattis (2000) | Mother/not specified | Joined the end of adolescent sessions 1, 4, 7, 11 | 4 (60-min) | X | – | – | X | – | X | – | – | Not reported |
Leyfer et al. (2018) | Not specified | Parent component at the end of each adolescent session. Parent involvement was identical in both arms | 6 (30-min) | X | – | – | X | X | X | – | X | Not reported |
Ollendick (1995) | Mother | Joined adolescent sessions | Not specified | – | – | – | – | X | X | – | – | Not reported |
Pincus et al. (2010) | Not specified | Joined the end of adolescent sessions 1, 4, 7, 11 | 5 (10-min) | X | – | – | – | X | X | X | – | Reported that parents felt the best part of treatment was learning a common language to use with adolescent and learning how to best help their adolescent while experiencing a panic attack (measures and participant numbers not specified) |
Separate parent sessions | ||||||||||||
Anderson et al. (1998) | Not specified | Separate parent sessions | 7 (not specified) | X | – | – | – | X | – | – | – | Not reported |
Baer and Garland (2005) | Not specified | Separate parent group session | 1 (not specified) | X | – | – | – | – | – | – | – | Not reported |
Legerstee et al. (2008) | Not specified | Separate parent sessions | 4 (90-min) | – | – | – | – | – | – | – | – | Not reported |
Masia-Warner et al. (2005) | Not specified | Parent group sessions | 2 (45-min) | X | – | – | – | X | – | – | – | Not reported |
Masia-Warner et al. (2007) | Not specified | Parent group sessions | 2 (45-min) | X | – | – | – | X | – | – | – | 4 questions assessing views of therapist skill, knowledge, overall satisfaction, and likelihood of recommending SASS. Reported that parents of adolescents in SASS group had significantly higher ratings than the attention control group (p < .05) but satisfaction was not related to parent ratings of improvement (participant numbers not specified) |
Masia-Warner et al. (2016) | Not specified | Parent group sessions | 2 (45-min) | X | – | – | – | X | – | – | – | Not reported |
Nordh et al. (2017) | Not specified | Separate internet-delivered parent sessions | 5 (not specified) | X | - | X | – | X | X | X | X | Not reported |
Spence et al. (2008) | Mother | Separate internet-delivered parent sessions | 5 (not specified) | X | X | X | X | X | X | – | – | Mother completed 8-item questionnaire. Reported ‘high levels’ of satisfaction and that the program had taught skills to manage anxiety and cope better with anxiety-provoking situations |
Spence et al. (2011) | Not specified | Separate internet-delivered or face-to-face parent sessions dependent on treatment arm | 5 (60-min) 2 booster sessions (not specified) | X | X | X | X | X | X | – | – | 88.64% of parents completed an adapted questionnaire. Reported moderate to high satisfaction, although parents in face-to-face condition reported ‘slightly higher’ satisfaction |
Waite et al. (2019) | Not specified | Separate internet-delivered parent sessions | 5 (not specified) | X | X | X | X | X | X | – | – | 71.7% (97.7% treatment completers). Reported that 95.3% of parents who had completed parent sessions and 81.9% of parents who had not completed parent sessions were ‘moderately’ to ‘extremely’ satisfied with their adolescent’s treatment |
Separate parent sessions and joint parent–adolescent sessions | ||||||||||||
Kendall and Barmish (2007) | Mother and father | Separate parent sessions and attended adolescent sessions | 2 (60-min) 5 (60-min) | X | – | – | – | – | X | X | – | Not reported |
Siqueland et al. (2005)a | Mothers and fathers | Separate parent sessions in CBT-only arm | 2 (not specified) | – | – | – | – | – | X | – | – | Not reported |
Separate parent sessions and parent–adolescent sessions in CBT-ABFT arm | 2 (not specified) | – | – | – | – | X | X | X | – | In informal exit interviews, parents in CBT-ABFT arm were reported to find the family work to be the ‘most important or satisfying’ treatment component. ‘Some’ parents in CBT alone arm ‘expressed disappointment’ in the limited parental involvement in treatment (participant numbers not specified) | ||
Workbook | ||||||||||||
Stjerneklar et al. (2018) | Not specified | Separate parent workbook, phone calls with therapist and individualised involvement in adolescent sessions | Not specified | X | – | – | X | – | X | – | – | 83.33% of parents completed CHI-ESQ; parents were reported to be ‘generally satisfied’ with the intervention, although 1/3 of parents would have liked a face-to-face meeting pre-treatment with the therapist/other families |
Wuthrich et al. (2012) | Mothers | Separate parent workbook and individualised involvement in adolescent sessions | 4 (not specified) | X | – | – | – | – | X | – | – | Not reported |
Format not specified | ||||||||||||
Leigh and Clark (2016) | Not specified | Individualised | Not specified | X | – | – | – | X | – | X | X | 100% of parents completed CHI-ESQ. Reported ‘high level’ of satisfaction as all endorsed all items as ‘partly’ or ‘certainly’ true |