Journal of the American Academy of Child & Adolescent Psychiatry
New ResearchCognitive-Behavioral Treatment Versus an Active Control for Children and Adolescents With Anxiety Disorders: A Randomized Trial
Section snippets
Participants
Participants in the study were 112 children aged 7 to 16 years (64 boys) meeting criteria for a principal (most impairing) anxiety disorder according to DSM-IV.12 Anxiety disorders were assessed using the Anxiety Disorders Interview Schedule for DSM-IV, Parent and Child Versions (ADIS-IV-C/P).13 Exclusion criteria were mental retardation, psychoses, and concurrent psychological treatment. Children on anxiety or depression medication were included (n = 6) if the dose was stable during treatment.
Comparison of Treatment Completers and Treatment Dropouts
Children who dropped out of treatment were older than treatment completers, t112 = 3.11, p = .00 (completers: mean 113 months, SD 31; attrition cases, mean = 149 months, SD 38). There were no other significant differences between attrition cases and completers (p > .05).
Pretreatment Comparisons
The two conditions were compared on demographic and pretreatment symptom measures (Table 1, Table 2). The children in the CBT group had a higher total clinical severity for anxiety compared with the children in the GSA group, t
Diagnostic Changes at Posttreatment and Follow-Up Across Conditions
At follow-up, a significantly greater proportion of children in the CBT condition were free of their principal anxiety diagnosis (i.e., CSR of principal anxiety diagnosis was less than 4) compared with the children in the GSA condition, and a trend difference was observed at posttreatment (Table 3). At posttreatment and follow-up, a significantly greater proportion of children in the CBT condition no longer met criteria for any anxiety diagnoses (i.e., all anxiety diagnoses had CSRs less than
Symptom Measures and Diagnostic Severity Across Time and Condition
Mixed model analyses were fitted to clinical severity ratings, child-reported symptoms, and mother-reported symptoms. Table 2, Table 4 provide descriptive statistics for the outcome variables and the slopes and intercepts for the model, respectively. Analyses using the intent-to-treat and completer samples produced comparable results. Also, results were comparable regardless of controlling for initial total clinical severity.
Discussion
The aim of the present study was to examine whether a treatment package containing training in specific cognitive-behavioral skills was more efficacious in treating childhood anxiety than a package that contained nonspecific therapy components. The study addressed some of the limitations of previous research by using diagnostic and questionnaire data from multiple informants, including a larger sample of clinical children with a variety of broad-based anxiety disorders and attempting to
References (36)
- et al.
Cognitive-behavioral treatment of school phobia
J Am Acad Child Adolesc Psychiatry
(1998) - et al.
Treatment of childhood anxiety disorders: a preliminary comparison between cognitive-behavioral group therapy and a psychological placebo intervention
J Behav Ther Exp Psychiatry
(2002) A measure of anxiety symptoms among children
Behav Res Ther
(1998)- et al.
A parent-report measure of children's anxiety: psychometric properties and comparison with child-report in a clinic and normal sample
Behav Res Ther
(2004) Psychometric properties of the Strengths and Difficulties Questionnaire
J Am Acad Child Adolesc Psychiatry
(2001)- et al.
Evaluation of therapist-supported parent-implemented CBT for anxiety disorders in rural children
Behav Res Ther
(2006) - et al.
Credibility of analogue therapy rationales
J Behav Ther Exp Psychiatry
(1972) - et al.
A symptom-level examination of parent-child agreement in the diagnosis of anxious youths
J Am Acad Child Adolesc Psychiatry
(2004) Treating anxiety disorders in children: results of a randomized clinical trial
J Consult Clin Psychol
(1994)- et al.
Systematic review of the efficacy of cognitive behaviour therapies for childhood and adolescent anxiety disorders
Br J Clin Psychol
(2004)
From temperament to disorder: an etiological model of generalized anxiety disorder
Comparative studies of psychotherapies. Is it true that everyone has won and all must have prizes
Arch Gen Psychiatry
Prediction of treatment outcome from relationship variables in child and adolescent therapy: a meta-analytic review
J Consult Clin Psychol
Research summary on the therapeutic relationship and psychotherapy outcome
Psychotherapy
Cognitive-behavioral therapy for anxiety disordered youth: a randomized clinical trial evaluating child and family modalities
J Consult Clin Psychol
Contingency management, self-control, and education support in the treatment of childhood phobic disorders: a randomized clinical trial
J Consult Clin Psychol
Behavioral treatment of childhood social phobia
J Consult Clin Psychol
Diagnostic and Statistical Manual of Mental Disorders
Cited by (131)
Anxiety disorders in children and adolescents: A summary and overview of the literature
2023, Behaviour Research and TherapyCognitive-behavioral therapy for children with anxiety in Japan: Bidirectional cultural adaptation and cross-cultural comparison studies
2023, Handbook of Lifespan Cognitive Behavioral Therapy: Childhood, Adolescence, Pregnancy, Adulthood, and AgingPreventative Interventions for Childhood and Adolescent Disorders
2022, Comprehensive Clinical Psychology, Second EditionOutcome Findings and Issues in Psychotherapy With Children and Adolescents: Internalizing Disorders
2022, Comprehensive Clinical Psychology, Second Edition
The authors are with the Centre for Emotional Health, Department of Psychology, Macquarie University.
The research was supported by a Macquarie University internal grant.
The authors thank Dr. Alan Taylor for assisting with the statistical analyses. The authors also thank the staff and therapists at the Macquarie University Anxiety Research Unit in collecting these data, including Jonathon Gaston, Joel Roast, Leigh Carpenter, Josephine Farrell, Lee Taylor, Jacqueline Frei, and Danielle Ellis.
Clinical trial registration information—Australian New Zealand Clinical Trials Registry (ANZCTR). URL: http://www.ANZCTR.org.au/ACTRN12608000522314.aspx. Unique identifier: ACTRN12608000522314.