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Cognitive-Behavioral Treatment Versus an Active Control for Children and Adolescents With Anxiety Disorders: A Randomized Trial

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Abstract

Objectives

The current trial examined whether a specific cognitive-behavioral treatment package was more efficacious in treating childhood anxiety disorders than a nonspecific support package.

Method

One hundred twelve children (aged 7-16 years) with a principal anxiety disorder were randomly allocated to either a group cognitive-behavioral treatment (CBT) program or a control condition (group support and attention [GSA]).

Results

Overall, results showed that CBT was significantly more efficacious compared with the GSA condition: 68.6% of children in the CBT condition did not meet diagnostic criteria for their principal anxiety diagnosis at 6-month follow-up compared with 45.5% of the children in the GSA condition. The results of the child- and parent-completed measures indicated that, although mothers of CBT children reported significantly greater treatment gains than mothers of GSA children, children reported similar improvements across conditions.

Conclusions

Specific delivery of cognitive-behavioral skills is more efficacious in the treatment of childhood anxiety than a treatment that includes only nonspecific therapy factors.

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

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    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.

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