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Low intensity treatment for clinically anxious youth: a randomised controlled comparison against face-to-face intervention

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Abstract

Methods to deliver empirically validated treatments for anxious youth that require fewer therapist resources (low intensity) are beginning to emerge. However, the relative efficacy of low-intensity treatment for youth anxiety against standard face-to-face delivery has not been comprehensively evaluated. Young people aged 6–16 years with a primary anxiety disorder (N = 281) were randomly allocated to treatment delivered either face-to-face or in a low-intensity format. Face-to-face treatment comprised ten, 60-min sessions delivered by a qualified therapist. Low intensity comprised information delivered in either printed (to parents of children under 13) or electronic (to adolescents aged 13 +) format and was supported by up to four telephone sessions with a minimally qualified therapist. Youth receiving face-to-face treatment were significantly more likely to remit from all anxiety disorders (66%) than youth receiving low intensity (49%). This difference was reflected in parents’ (but not child) reports of child’s anxiety symptoms and life interference. No significant moderators were identified. Low intensity delivery utilised significantly less total therapist time (175 min) than face-to-face delivery (897 min) and this was reflected in a large mean difference in therapy costs ($A735). Standard, face-to-face treatment for anxious youth is associated with significantly better outcomes than delivery of similar content using low-intensity methods. However, the size of this difference was relatively small. In contrast, low-intensity delivery requires markedly less time from therapists and subsequently lower treatment cost. Data provide valuable information for youth anxiety services.

Clinical trial registration information: A randomised controlled trial of standard care versus stepped care for children and adolescents with anxiety disorders; https://anzctr.org.au/; ACTRN12612000351819.

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Notes

  1. Based on Australian Medical Benefits Schedule, 2015/2016.

  2. In fact, the same pattern of results was shown across all dependent variables.

References

  1. Rapee RM, Schniering CA, Hudson JL (2009) Anxiety disorders during childhood and adolescence: origins and treatment. Annu Rev Clin Psychol 5:311–341. https://doi.org/10.1146/annurev.clinpsy.032408.153628

    Article  PubMed  Google Scholar 

  2. Reynolds S, Wilson C, Austin J, Hooper L (2012) Effects of psychotherapy for anxiety in children and adolescents: a meta-analytic review. Clin Psychol Rev 32(4):251–262

    Article  Google Scholar 

  3. Ishikawa S-I, Okajima I, Matsuoka H, Sakano Y (2007) Cognitive behavioural therapy for anxiety disorders in children and adolescents: a meta-analysis. Child Adolesc Mental Health 12(4):164–172

    Article  Google Scholar 

  4. Ewing DL, Monsen JJ, Thompson EJ, Cartwright-Hatton S, Field A (2015) A meta-analysis of transdiagnostic cognitive behavioural therapy in the treatment of child and young person anxiety disorders. Behav Cognit Psychother 43(5):562–577

    Article  Google Scholar 

  5. Rapee RM, Abbott MJ, Lyneham HJ (2006) Bibliotherapy for children with anxiety disorders using written materials for parents: a randomized controlled trial. J Consult Clin Psychol 74(3):436–444

    Article  Google Scholar 

  6. Thirlwall K, Cooper PJ, Karalus J, Voysey M, Willetts L, Creswell C (2013) Treatment of child anxiety disorders via guided parent-delivered cognitive-behavioural therapy: randomised controlled trial. Br J Psychiatry 203(6):436–444

    Article  Google Scholar 

  7. Spence SH, Holmes JG, March S, Lipp OV (2006) The feasibility and outcome of clinic plus internet delivery of cognitive-behavior therapy for childhood anxiety. J Consult Clin Psychol 74(3):614–621

    Article  Google Scholar 

  8. Khanna MS, Kendall PC (2010) Computer-assisted cognitive behavioral therapy for child anxiety: results of a randomized clinical trial. J Consult Clin Psychol 78(5):737–745

    Article  Google Scholar 

  9. Rooksby M, Elouafkaoui P, Humphris G, Clarkson J, Freeman R (2015) Internet-assisted delivery of cognitive behavioural therapy (CBT) for childhood anxiety: systematic review and meta-analysis. J Anxiety Disord 29:83–92

    Article  Google Scholar 

  10. Pennant ME, Loucas CE, Whittington C, Creswell C, Fonagy P, Fuggle P, Kelvin R, Naqvi S, Stockton S, Kendall T (2015) Computerised therapies for anxiety and depression in children and young people: a systematic review and meta-analysis. Behav Res Ther 67:1–18

    Article  Google Scholar 

  11. Spence SH, Donovan CL, March S, Gamble A, Anderson RE, Prosser S, Kenardy J (2011) A randomized controlled trial of online versus clinic-based CBT for adolescent anxiety. J Consult Clin Psychol 79(5):629–642

    Article  Google Scholar 

  12. Rapee RM, Lyneham HJ, Wuthrich V, Chatterton M-L, Hudson JL, Kangas M, Mihalopoulos C (2017) Comparison of stepped care delivery against a single, empirically validated CBT program for anxious youth: a randomized clinical trial. J Am Acad Child Adolesc Psychiatry 56(10):841–848. https://doi.org/10.1016/j.jaac.2017.08.001

    Article  Google Scholar 

  13. Rapee RM, Lyneham HJ, Schniering CA, Wuthrich V, Abbott MJ, Hudson JL, Wignall A (2006) The Cool Kids® child and adolescent anxiety program therapist manual. Macquarie University, Sydney Centre for Emotional Health, Sydney

    Google Scholar 

  14. Hudson JL, Rapee RM, Deveney C, Schniering CA, Lyneham HJ, Bovopoulous N (2009) Cognitive behavioral treatment versus an active control for children and adolescents with anxiety disorders: a randomized trial. J Am Acad Child Adolesc Psychiatry 48(5):533–544

    Article  Google Scholar 

  15. Arendt K, Thastum M, Hougaard E (2015) Efficacy of a Danish version of the Cool Kids program: a randomized wait-list controlled trial. Acta Psychiatr Scand. https://doi.org/10.1111/acps.12448

    Article  PubMed  Google Scholar 

  16. Wuthrich VM, Rapee RM, Cunningham MJ, Lyneham HJ, Hudson JL, Schniering CA (2012) A randomized controlled trial of the Cool Teens CD-ROM computerized program for adolescent anxiety. J Am Acad Child Adolesc Psychiatry 51(3):261–270

    Article  Google Scholar 

  17. Silverman WK, Albano AM (1996) The anxiety disorders interview schedule for children-IV (child and parent versions). Psychological Corporation, San Antonio

    Google Scholar 

  18. McLellan LF, Iverach L, Kangas M, Wuthrich V, Hudson JL, Rapee RM, Lyneham HJ (2020) The Youth Online Diagnostic Assessment (YODA): Validity of a New Tool to Assess Anxiety Disorders in Youth. Child Psychiatry Hum Dev. https://doi.org/10.1007/s10578-020-01007-3

    Article  Google Scholar 

  19. Spence SH (1998) A measure of anxiety symptoms among children. Behav Res Ther 36(5):545–566. https://doi.org/10.1016/S0005-7967(98)00034-5

    Article  CAS  PubMed  Google Scholar 

  20. Nauta MH, Scholing A, Rapee RM, Abbott M, Spence SH (2004) Development of a parent report measure of children’s anxiety: psychometric properties and comparison with child report in a clinic and normal sample. Behav Res Ther 42:813–839. https://doi.org/10.1016/S0005-7967(03)00200-6

    Article  PubMed  Google Scholar 

  21. Lyneham HJ, Sburlati ES, Abbott MJ, Rapee RM, Hudson JL, Tolin DF, Carlson SE (2013) Psychometric properties of the child anxiety life interference scale (CALIS). J Anxiety Disord 27(7):711–719. https://doi.org/10.1016/j.janxdis.2013.09.008

    Article  PubMed  Google Scholar 

  22. Williams C, Martinez R (2008) Increasing access to CBT: stepped care and CBT self-help models in practice. Behav Cognit Psychother 36(6):675–683

    Article  Google Scholar 

  23. Lyneham HJ, Rapee RM (2006) Evaluation of therapist supported parent-implemented CBT for anxiety disorders in rural children. Behav Res Ther 44:1287–1300

    Article  Google Scholar 

  24. Salloum A (2010) Minimal therapist-assisted cognitive-behavioral therapy interventions in stepped care for childhood anxiety. Prof Psychol Res Pract 41(1):41–47

    Article  Google Scholar 

  25. Van der Leeden AJM, Van Widenfelt BM, van der Leeden R, Liber JM, Utens EMWJ, Treffers PDA (2011) Stepped care cognitive behavioural therapy for children with anxiety disorders: a new treatment approach. Behav Cognit Psychother 39:55–75

    Article  Google Scholar 

  26. McLellan LF, Fitzpatrick S, Schniering CA, Rapee RM (2019) Self-help treatment of childhood anxiety disorders. In: Farrell LJ, Ollendick TH, Muris P (eds) Innovations in CBT for childhood anxiety, OCD, and PTSD: improving access & outcomes. Cambridge University Press, Cambridge, pp 52–72. https://doi.org/10.1017/9781108235655.004

  27. Vos T, Haby M, Magnus A, Mihalopoulos C, Andrews G, Carter R (2005) Assessing cost-effectiveness in mental health: helping policy-makers prioritize and plan health services. Aust N Z J Psychiatry 39:701–712

    Article  Google Scholar 

  28. Chatterton M-L, Rapee RM, Catchpool M, Lyneham HJ, Wuthrich V, Hudson JL, Kangas M, Mihalopoulos C (2017) Economic evaluation of a stepped care approach for the management of childhood anxiety disorders: results from a randomised trial. Aust N Z J Psychiatry 53(7):673–682. https://doi.org/10.1177/0004867418823272

    Article  Google Scholar 

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Acknowledgements

The research was supported by National Health and Medical Research Council grant APP1027556. The authors would like to thank the research staff and therapists who worked on this project. Particular thanks are expressed to Annabel Price, DPT, and Kathryn Preece, MCP, of the Department of Psychology, Macquarie University for management of the trial.

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Authors and Affiliations

  1. Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney. NSW, 2109, Australia

    Ronald M. Rapee, Heidi J. Lyneham, Viviana Wuthrich, Jennifer L. Hudson & Maria Kangas

  2. Deakin Health Economics, School of Health and Social Development, Deakin University Melbourne, VIC, 3125, Australia

    Mary Lou Chatterton & Cathrine Mihalopoulos

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  1. Ronald M. Rapee
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  2. Heidi J. Lyneham
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Correspondence to Ronald M. Rapee.

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Conflict of interest

Drs Rapee, Lyneham, Wuthrich, & Hudson are authors of the Cool Kids program that is used in this research but receive no royalties. Drs Rapee and Lyneham are authors of the book “Helping your anxious child” that is used in the parent self-help arm and receive royalties.

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Rapee, R.M., Lyneham, H.J., Wuthrich, V. et al. Low intensity treatment for clinically anxious youth: a randomised controlled comparison against face-to-face intervention. Eur Child Adolesc Psychiatry 30, 1071–1079 (2021). https://doi.org/10.1007/s00787-020-01596-3

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