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Galí D, Forcadell E, Primé-Tous M, Puig O, Lera-Miguel S. Cool Kids: Cognitive Behavioral Therapy in a Spanish Sample of Children and Adolescents with Anxiety Disorders. Child Psychiatry Hum Dev 2025; 56:751-757. [PMID: 37672194 DOI: 10.1007/s10578-023-01579-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/28/2023] [Indexed: 09/07/2023]
Abstract
Anxiety disorders (ADs) negatively impact functioning and life quality. Studies on cognitive behavioral therapy (CBT) have demonstrated its short- and long-term efficacy. Cool Kids (CK) is a 10-session CBT-based group program administered to participants with ADs aged 7-17 years and their parents, and it has demonstrated efficacy compared with control groups. This study analyzes the effectiveness of CK in a clinical cohort of Spanish children and adolescents with ADs. CK was offered to 57 patients with AD and their caregivers at the Hospital Clínic, Barcelona. In all global registered measures, the results demonstrated a reduction of symptoms and their interference in daily functioning. Moreover, a significant improvement was observed in participants who completed more sessions. Thus, CK reduced the severity of anxiety and its interference over individual and family functioning.
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Affiliation(s)
- Dafne Galí
- University of Barcelona, Barcelona, Spain.
| | - Eduard Forcadell
- Department of Child and Adolescent Psychiatry and Psychology, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Mireia Primé-Tous
- Department of Child and Adolescent Psychiatry and Psychology, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Olga Puig
- Departament of Child and Adolescent Psychiatry and Psychology, Hospital Clínic of Barcelona, 2021SGR01319, IDIBAPS, CIBERSAM, Barcelona, Spain
| | - Sara Lera-Miguel
- Department of Child and Adolescent Psychiatry and Psychology, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
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2
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Rapee RM, Creswell C, Kendall PC, Pine DS, Waters AM. Anxiety disorders in children and adolescents: A summary and overview of the literature. Behav Res Ther 2023; 168:104376. [PMID: 37499294 DOI: 10.1016/j.brat.2023.104376] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 07/10/2023] [Accepted: 07/17/2023] [Indexed: 07/29/2023]
Abstract
Considerable work has advanced understanding of the nature, causes, management, and prevention of anxiety disorders in children and adolescents over the past 30 years. Prior to this time the primary focus was on school refusal and specific phobias. It is now recognised that children and adolescents experience the full gamut of anxiety disorders in very similar ways to adults and that anxiety disorders in the paediatric years can predict a lifelong mental-health struggle. Given the vast array of specific studies in this field, the current review summarises current knowledge about these high prevalence disorders, points to overarching limitations, and suggests potentially important future directions. Following a brief historical overview, the review summarises knowledge about demographic and epidemiological characteristics, distal and proximal risk factors, current treatment directions, and prevention. There is still a great deal to learn about the causes and treatments of child and adolescent anxiety disorders. By amalgamating our current knowledge, this review provides a window to the research directions that are likely to lead to future advances.
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Affiliation(s)
- Ronald M Rapee
- Centre for Emotional Health, School of Psychological Sciences, Macquarie University, Sydney, Australia.
| | - Cathy Creswell
- Departments of Psychiatry and Experimental Psychology, University of Oxford, Oxford, UK
| | - Philip C Kendall
- Department of Psychology, Temple University, Child and Adolescent Anxiety Disorders Clinic, USA
| | - Daniel S Pine
- National Institute of Mental Health Intramural Research Program (NIMH-IRP), USA
| | - Allison M Waters
- School of Applied Psychology, Griffith University, Brisbane, Australia
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3
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Kilburn TR, Sørensen MJ, Thastum M, Rapee RM, Rask CU, Arendt KB, Carlsen AH, Thomsen PH. Group Based Cognitive Behavioural Therapy for Anxiety in Children with Autism Spectrum Disorder: A Randomised Controlled Trial in a General Child Psychiatric Hospital Setting. J Autism Dev Disord 2023; 53:525-538. [PMID: 32219638 DOI: 10.1007/s10803-020-04471-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Cognitive Behavioural Therapy (CBT) programs adapted to children with Autism Spectrum Disorder (ASD) effectively reduce anxiety when run in university clinics. Forty-nine children aged 8-14 years participated in a waitlist controlled study in a general child psychiatric hospital setting. Post-treatment 30% of the children were free of their primary anxiety diagnoses and 5% were free of all anxiety diagnoses. No statistically significant difference between the two trial conditions were found on primary outcomes. However, statistically significant differences were found on secondary outcomes indicating clinically meaningful treatment responses. Together with high program satisfaction this study shows the CBT program to be feasible and potentially efficacious in treating anxiety in children with ASD in a general child psychiatric hospital setting.
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Affiliation(s)
- Tina R Kilburn
- Research Unit, Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Psychiatry, Palle Juul Jensens Boulevard 175, 8200, Aarhus N, Denmark.
| | - Merete J Sørensen
- Department of Child and Adolescent Psychiatry, Psychiatric Clinic for School Aged Children, Aarhus University Hospital, Psychiatry, Aarhus, Denmark
| | - Mikael Thastum
- Department of Psychology and Behavioural Science, Aarhus University, Aarhus, Denmark
| | - Ronald M Rapee
- Department of Psychology, Centre for Emotional Health, Macquarie University, Sydney, Australia
| | - Charlotte U Rask
- Research Unit, Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Psychiatry, Palle Juul Jensens Boulevard 175, 8200, Aarhus N, Denmark
- Department of Child and Adolescent Psychiatry, Psychiatric Clinic for School Aged Children, Aarhus University Hospital, Psychiatry, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Kristian B Arendt
- Department of Psychology and Behavioural Science, Aarhus University, Aarhus, Denmark
| | - Anders H Carlsen
- Research Unit, Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Psychiatry, Palle Juul Jensens Boulevard 175, 8200, Aarhus N, Denmark
| | - Per H Thomsen
- Research Unit, Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Psychiatry, Palle Juul Jensens Boulevard 175, 8200, Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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4
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A Randomized Controlled Trial of a Cognitive Behavior Therapy Program for Children with Clinical Anxiety Symptoms. PSYCHIATRY INTERNATIONAL 2021. [DOI: 10.3390/psychiatryint2020016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
High anxiety and anxiety disorders are among the most prevalent mental health problems in children and lead to significant interference with children’s daily functioning. Most empirical evaluations of treatment come from English-language countries. The aim of the present study was to evaluate and replicate the effectiveness of a cognitive-behavioral intervention program to manage anxiety in children among children from Greece. Forty-one children–parent(s) dyads participated in the study. Children were 9–12 years old, with clinically elevated symptoms of anxiety, and they were assigned to either the standard group treatment (cognitive behavior therapy (CBT)) or to a waitlist group (WL). Both children and their parents in the CBT group reported statistically significant reductions in children’s anxiety symptoms at post-intervention and at the 6-month follow-up. A significant reduction was also found in life interference due to anxiety according to both child and parent reports. In contrast, no significant changes in anxiety symptoms or life interference were reported among the WL. The current results support the effectiveness of a CBT program for anxious children from a non-clinic, non-school setting in Greece.
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Schneider RA, Grasso JR, Chen SY, Chen C, Reilly ED, Kocher B. Beyond the Lab: Empirically Supported Treatments in the Real World. Front Psychol 2020; 11:1969. [PMID: 32849153 PMCID: PMC7432146 DOI: 10.3389/fpsyg.2020.01969] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 07/16/2020] [Indexed: 11/13/2022] Open
Abstract
Laboratory studies of empirically supported treatments (ESTs) for mental health problems achieve much higher rates of clinical improvement than has been observed following treatment in the community. This discrepancy is likely to due to limited reliance on ESTs by therapists outside of academia. Concerns about the generalizability of ESTs to patients in the community, who may have comorbid problems, likely limit rates of adoption. The present study examined the impact of ESTs delivered in the real-world for 1,256 adults who received services through an employee assistance program specializing in the delivery of ESTs. Rates of anxiety and depression decreased significantly, following treatment with an EST, and 898 (71.5%) patients demonstrated reliable improvement. Even among patients comorbid for depression and anxiety at baseline, over half reported reliable improvement in both disorders. Findings suggest ESTs can be effectively delivered outside of academic RCTs. However, additional research is needed to understand and overcome barriers to disseminating ESTs to the broader community.
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Affiliation(s)
| | | | | | - Connie Chen
- Lyra Health, Burlingame, CA, United States.,Department of General Internal Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Erin D Reilly
- Department of Psychiatry, University of Massachusetts System, Boston, MA, United States
| | - Bob Kocher
- Lyra Health, Burlingame, CA, United States.,School of Medicine, Stanford University, Stanford, CA, United States
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Providers’ Experiences with Delivering School-Based Targeted Prevention for Adolescents with Anxiety Symptoms: A Qualitative Study. SCHOOL MENTAL HEALTH 2020. [DOI: 10.1007/s12310-020-09382-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
AbstractThe school setting is important for delivering targeted prevention to adolescents with anxiety. However, schools may not have available providers with training or experience in delivering evidence-based interventions, e.g., school psychologists. Training providers available in the schools, e.g., school nurses, is important. Further, to investigate their experiences in delivering targeted prevention to adolescents with anxiety could help understand factors promoting implementation success. A qualitative study including focus groups with providers of school-based targeted prevention cognitive-behavioral therapy for anxiety in adolescents was conducted. Focus group interviews were audiotaped and transcribed verbatim. Systematic Text Condensation, a method for thematic cross-case analysis was used. The Active Implementation Framework (AIF) was used to contextualize the results. Seventeen providers participated in the study. They reported several facilitators contributing to successful implementation: Their feeling of competence in delivering the interventions were built through skills-based training, supervision, and collegial support. Conducting initial assessment of each adolescent helped the providers individualize the interventions. Seeing positive outcomes in adolescents gave the providers motivation to continue implementation. Further, collaborating with teachers facilitated both recruitment of adolescents and administering group sessions. Minimal leadership-oriented factors were reported. Overall, the findings correspond to some of the drivers in AIF. This study offers providers’ perspectives on implementation of targeted prevention for anxiety in the school setting. Our results show that providers experience mastery in delivery when receiving support, training, and supervision. This seems to be essential facilitators for implementing much needed targeted prevention for youth with anxiety.
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Bear HA, Edbrooke-Childs J, Norton S, Krause KR, Wolpert M. Systematic Review and Meta-analysis: Outcomes of Routine Specialist Mental Health Care for Young People With Depression and/or Anxiety. J Am Acad Child Adolesc Psychiatry 2020; 59:810-841. [PMID: 31881268 DOI: 10.1016/j.jaac.2019.12.002] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 11/30/2019] [Accepted: 12/19/2019] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Depression and anxiety are the most prevalent mental health problems in youth, yet almost nothing is known about what outcomes are to be expected at the individual level following routine treatment. This paper sets out to address this gap by undertaking a systematic review of outcomes following treatment as usual (TAU) with a particular focus on individual-level outcomes. METHOD MEDLINE, Embase and PsycInfo were searched for articles published between 1980 and January 2019 that assessed TAU outcomes for youth depression and anxiety accessing specialist mental health care. Meta-analysis considered change at both group-level pre-post effect size (ES) and individual-level recovery, reliable change, and reliable recovery. Temporal analysis considered stability of primary and secondary outcomes over time. Subgroup analysis considered the moderating effect of informant; presenting problem; study design; study year; mean age of youth; use of medication; intervention dosage and type of treatment offered on outcomes. A protocol was preregistered on PROSPERO (CRD42017063914). RESULTS Initial screening of 6,350 publications resulted in 38 that met the inclusion criteria, and that were subsequently included in meta-analyses. This resulted in a final full pooled sample of 11,739 young people (61% of whom were female, mean age 13.8 years). The pre-post ES (Hedges' g) at first/final outcome (13/26 weeks) was -0.74/-0.87. The individual-level change on measures of self-report was 38% reliable improvement, 44% no reliable change, and 6% reliable deterioration. Outcomes varied according to moderators, informant, problem type and dosage. CONCLUSION Poor data quantity and quality are limitations, but this is the first study that indicates likely rates of reliable improvement for those accessing TAU. We propose the need for improved reporting of both individual-level metrics and details of TAU to enable greater understanding of likely current outcomes from routine care for youths with depression and anxiety in order to allow the potential for further improvement of impact.
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Affiliation(s)
- Holly Alice Bear
- University College London, UK; Anna Freud National Centre for Children and Families; The Kantor Centre of Excellence, London, UK.
| | - Julian Edbrooke-Childs
- University College London, UK; Anna Freud National Centre for Children and Families; The Kantor Centre of Excellence, London, UK; Child Outcomes Research Consortium, Brunswick Place London, UK
| | - Sam Norton
- Health Psychology Section at the Institute of Psychiatry, Psychology & Neuroscience, King's College London, Guy's Hospital Campus, London Bridge, London, UK
| | - Karolin Rose Krause
- University College London, UK; Anna Freud National Centre for Children and Families; The Kantor Centre of Excellence, London, UK
| | - Miranda Wolpert
- University College London, UK; Anna Freud National Centre for Children and Families; The Kantor Centre of Excellence, London, UK; Child Outcomes Research Consortium, Brunswick Place London, UK
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Fjermestad KW, Wergeland GJ, Rogde A, Bjaastad JF, Heiervang E, Haugland BSM. School-based targeted prevention compared to specialist mental health treatment for youth anxiety. Child Adolesc Ment Health 2020; 25:102-109. [PMID: 32307836 DOI: 10.1111/camh.12366] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/12/2019] [Indexed: 12/01/2022]
Abstract
BACKGROUND The 'FRIENDS for life' program (FRIENDS) is a 10-session cognitive behavioral therapy (CBT) program used for prevention and treatment of youth anxiety. There is discussion about whether FRIENDS is best applied as prevention or as treatment. METHODS We compared FRIENDS delivered in schools as targeted prevention to a previous specialist mental health clinic trial. The targeted prevention sample (N = 82; Mage = 11.6 years, SD = 2.1; 75.0% girls) was identified and recruited by school nurses in collaboration with a community psychologist. The clinical sample (N = 88, Mage = 11.7 years, SD = 2.1; 54.5% girls) was recruited for a randomized controlled trial from community child- and adolescent psychiatric outpatient clinics and was diagnosed with anxiety disorders. RESULTS Both samples showed significantly reduced anxiety symptoms from baseline to postintervention, with medium mean effect sizes across raters (youths and parents) and timepoints (post; 12-months follow-up). Baseline youth-reported anxiety symptom levels were similar between the samples, whereas parent-reported youth anxiety was higher in the clinical sample. CONCLUSIONS The study suggests that self-reported anxiety levels may not differ between youth recruited in schools and in clinic settings. The results indicate promising results of the FRIENDS program when delivered in schools by less specialized health personnel from the school health services, as well as when delivered in clinics by trained mental health professionals.
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Affiliation(s)
- Krister W Fjermestad
- Department of Psychology, University of Oslo, Oslo, Norway.,Frambu Resource Centre for Rare Disorders, Siggerud, Norway
| | - Gro Janne Wergeland
- Regional Centre for Child and Youth Mental Health and Chile Welfare, NORCE Norwegian Research Centre, Bergen, Norway.,Psychiatric Division, Haukeland University Hospital, Bergen, Norway
| | | | - Jon F Bjaastad
- Regional Centre for Child and Youth Mental Health and Chile Welfare, NORCE Norwegian Research Centre, Bergen, Norway.,Division of Psychiatry, Stavanger University Hospital, Stavanger, Norway
| | | | - Bente Storm Mowatt Haugland
- Regional Centre for Child and Youth Mental Health and Chile Welfare, NORCE Norwegian Research Centre, Bergen, Norway.,Faculty of Psychology, University of Bergen, Bergen, Norway
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Effectiveness of Brief and Standard School-Based Cognitive-Behavioral Interventions for Adolescents With Anxiety: A Randomized Noninferiority Study. J Am Acad Child Adolesc Psychiatry 2020; 59:552-564.e2. [PMID: 31926224 DOI: 10.1016/j.jaac.2019.12.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 10/10/2019] [Accepted: 12/30/2019] [Indexed: 12/16/2022]
Abstract
OBJECTIVE We examined the effectiveness of targeted school-based cognitive-behavioral therapy (CBT) for adolescents (12-16 years of age) with anxiety, and tested whether brief CBT was noninferior to standard duration CBT. METHOD A randomized controlled study of 313 adolescents (mean 14.0 years, SD = 0.84, 84% girls) were recruited through school health services to 10 weeks CBT group interventions. Groups of 5 to 8 adolescents were randomly allocated to brief (5 sessions, comprising 5.5 hours) or standard CBT (10 sessions, comprising 15 hours), or 10 weeks waitlist (WL). Self-reported and parent-reported youth anxiety symptoms, impairment from anxiety, depressive symptoms,and clinical severity were assessed pre- and postintervention, after WL, and at 1-year follow-up. RESULTS Targeted school based CBT significantly reduced adolescents' anxiety symptoms with small to moderate effect sizes compared to WL (Cohen d = 0.34 for youth report and d = 0.53 for parent report). According to the parents, also adolescents' impairment from anxiety was significantly reduced compared to WL (d = 0.51). Pre to post changes in anxiety symptoms were small to moderate (within-group effect sizes between d = 0.41 and d = 0.67). Although no significant differences in effects were found between brief and standard CBT, brief CBT was not noninferior to standard CBT. Outcomes from both interventions were sustained at 1-year follow-up. CONCLUSION Targeted school-based CBT interventions reduced anxiety, impairment, and depressive symptoms in adolescents. Both brief and standard CBT demonstrated efficacy, but brief CBT was not noninferior to standard CBT. By administering school-based CBT to youths with anxiety symptoms, we may reach young people with effective interventions at an earlier phase in their lives. CLINICAL TRIAL REGISTRATION INFORMATION School Based Low-intensity Cognitive Behavioral Intervention for Anxious Youth (LIST); http://clinicalrials.gov/; NCT02279251.
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Johnsen DB, Arendt K, Thastum M. The efficacy of manualized Cognitive Behavior Therapy conducted by student-therapists treating Danish youths with anxiety using a benchmark comparison. Scand J Child Adolesc Psychiatr Psychol 2019; 7:68-80. [PMID: 33564625 PMCID: PMC7863729 DOI: 10.21307/sjcapp-2019-010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Background: Several systematic reviews have demonstrated the efficacy of cognitive behavioral therapy (CBT) treating anxiety disorders in children and adolescents (hereafter referred to as youths). Treatment of anxiety disorders conducted by student therapists (ST) has been found to be an effective alternative, to treatment conducted by psychologists. Objective: The primary aim of the study is to investigate the effects of ST treating youths, using a group-based CBT program. Second, the study aims to compare these results with outcomes achieved by professional-therapists (PT). Method: The study investigate in an open trial design, the treatment outcome from a manualized CBT program (Cool Kids) in a group of youths (n = 54) treated by ST. Results are benchmarked against the outcomes of a group of youths (n = 56) treated by PT using the same program, derived from a separate randomized controlled trial. Results: There was a significant reduction of both self-reported and clinician rated measures of youth anxiety over time in the ST group, with small to large effect sizes. No significant differences of improvements in self-report measures were found between the ST and the PT groups. There was no significant difference in remission rates for participants’ primary anxiety disorder between the ST (50.0%) and the PT (66.1%) at post-treatment or at three-month follow-up (ST: 74.1%, PT: 76.8%). There was a significant difference regarding number of youths free of all anxiety disorder between the ST (14 [25.9%]) and PT (27 [48.2%]) group at post-treatment. This difference was not significant at three-month follow-up (ST: 25 [46.3%], PT: 33 [58.9%]). Conclusion: The findings support previous findings, suggesting that student-therapists, receiving training and supervision, can successfully treat youths with anxiety disorders using a manualized CBT program. The outcomes following CBT treatment conducted by ST are comparable to outcomes achieved by PT.
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Affiliation(s)
- Daniel Bach Johnsen
- Department of Psychology and Behavioral Sciences, Aarhus University, Denmark
| | - Kristian Arendt
- Department of Psychology and Behavioral Sciences, Aarhus University, Denmark
| | - Mikael Thastum
- Department of Psychology and Behavioral Sciences, Aarhus University, Denmark
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Waite P, Marshall T, Creswell C. A randomized controlled trial of internet-delivered cognitive behaviour therapy for adolescent anxiety disorders in a routine clinical care setting with and without parent sessions. Child Adolesc Ment Health 2019; 24:242-250. [PMID: 32677216 DOI: 10.1111/camh.12311] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/11/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Computerized treatments have been shown to be effective in young people with anxiety disorders within research settings. The aims of this study were to evaluate a self-completed, therapist-supported online treatment for adolescent anxiety disorders in a routine clinical care setting and examine whether additional sessions for parents improved treatment outcome. METHOD Sixty adolescents (13-18 years) referred by primary and secondary care services for treatment of an anxiety disorder and their parent(s) were randomly allocated to begin treatment immediately or after a 16-week waitlist. Half the parents (receiving treatment immediately or after a waitlist) were allocated to receive sessions themselves. Assessments were conducted pre- and posttreatment and at 6-month follow-up. RESULTS There was no significant difference posttreatment between the immediate treatment and waitlist groups in remission of primary anxiety disorder (Odds Ratio (OR) = 2.19, 95% CI: 0.72-6.70). Parent sessions did not significantly improve adolescent outcomes immediately or at 6-month follow-up (OR = 0.75, 95% CI: 0.26-2.15; OR = 1.14, 95% CI: 0.42-3.15). CONCLUSIONS Within a routine clinical care setting, a therapist-supported online treatment failed to deliver significantly better outcomes for adolescents with anxiety disorders than a waitlist. Further research is needed to develop more effective treatments for this population.
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Affiliation(s)
- Polly Waite
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Tamsin Marshall
- CAMHS Anxiety & Depression Pathway, Berkshire Healthcare Foundation Trust, School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Cathy Creswell
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
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12
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Djurhuus ID, Bikic A. Is the Cool Kids programme working in outpatient psychiatric clinics? A Danish naturalistic effectiveness study. Nord J Psychiatry 2019; 73:141-148. [PMID: 30767588 DOI: 10.1080/08039488.2019.1574893] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND & AIM This study investigates the effectiveness of the Cool Kids programme in two outpatient psychiatric clinics for children with anxiety. Efficacy studies find that 60-80% of programme completers improve. It is unclear if the intervention is as effective in real-life clinical treatment, as only one previous Danish effectiveness study has ever been conducted. The goal of all evidence-based interventions is the successful transition from research environments to standard care clinical practice, but there can be substantial differences in the environment, therapists' education and patient population in the two settings. METHOD We have conducted a naturalistic effectiveness study of the Cool Kids programme using the Child Anxiety Life Interference Scale parent-report (N = 39) and child self-report (N = 40). CONCLUSION The intervention significantly decreased the interference caused by anxiety symptoms in both the children's and the parents' lives from pre- to post-treatment and results were maintained during the 3-month follow up. Nevertheless, no additional significant reduction in interference was detected in the follow up contrary to the results from previous efficacy studies. Our results confirm that Cool Kids can be successfully implemented in clinical practice.
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Affiliation(s)
- Ida Drejer Djurhuus
- a Department for Child and Adolescent Psychiatry Southern Jutland , Aabenraa , Denmark.,b Autism Centre Southern Denmark , Ringe , Denmark
| | - Aida Bikic
- a Department for Child and Adolescent Psychiatry Southern Jutland , Aabenraa , Denmark.,c Department of Regional Health Research , University of Southern Denmark , Odense , Denmark
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13
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Edbrooke-Childs J, Wolpert M, Zamperoni V, Napoleone E, Bear H. Evaluation of reliable improvement rates in depression and anxiety at the end of treatment in adolescents. BJPsych Open 2018; 4:250-255. [PMID: 29998818 PMCID: PMC6060492 DOI: 10.1192/bjo.2018.31] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 04/05/2018] [Accepted: 05/15/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Literature has focused on effect sizes rather than individual-level improvement rates to determine how effectively services address burgeoning numbers of adolescents with anxiety and depression.AimsTo consider how many adolescents report reliable improvement in anxiety, depression and comorbid depression and anxiety by end of treatment. METHOD The primary outcome was reliable improvement (i.e. change greater than likely the result of measurement error) in self-reported anxiety and depression for N = 4464 adolescents (mean age 14.5 years, s.d. = 1.9; 75% female; 61% White) seen in specialist mental health services in England. RESULTS In total, 53% of those with anxiety, 44% with depression, and 35% with comorbid depression and anxiety showed reliable improvement. CONCLUSIONS Improvement rates were higher than previously reported, but lower than generally used in advice to the public. There may be a need to set more realistic expectations, including with young people who seek help.Declaration of interestAll authors were involved in the programme of service transformation that this report draws on. M.W. led the outcomes and evaluation group that agreed the approach to measurement used in the initiative.
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Affiliation(s)
- Julian Edbrooke-Childs
- Lecturer, Evidence Based Practice Unit, Brain Sciences, UCL and Anna Freud National Centre for Children and Families, London, UK
| | - Miranda Wolpert
- Professor, Evidence Based Practice Unit, Brain Sciences, UCL and Anna Freud National Centre for Children and Families, London, UK
| | | | - Elisa Napoleone
- Research Officer, Child Outcomes Research Consortium, London, UK
| | - Holly Bear
- PhD student, Evidence Based Practice Unit, Brain Sciences, UCL and Anna Freud National Centre for Children and Families, London, UK
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14
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Kilburn TR, Sørensen MJ, Thastum M, Rapee RM, Rask CU, Arendt KB, Thomsen PH. Rationale and design for cognitive behavioral therapy for anxiety disorders in children with autism spectrum disorder: a study protocol of a randomized controlled trial. Trials 2018; 19:210. [PMID: 29609630 PMCID: PMC5879814 DOI: 10.1186/s13063-018-2591-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 03/13/2018] [Indexed: 12/05/2022] Open
Abstract
Background Autism spectrum disorder (ASD) is found in approximately 1% of the population and includes core symptoms that affect general and social development. Beside these core symptoms, it is suggested that up to 60% of children with ASD suffer from comorbid anxiety disorders which may further affect educational, social and general development as well as quality of life. The main goal of this study is to examine the effectiveness of a manualized cognitive behavioral therapy (CBT) anxiety program adapted for children with ASD. Methods This study is a randomized controlled trial (RCT). Fifty children with ASD and anxiety, aged 7 to 13 years, will be randomly assigned to group CBT or a wait-list control (WL) condition. The design will follow a two (CBT and WL) by two (pre–post assessment) mixed between–within design. The control group will receive intervention after the waitlist period of 13 weeks. Primary outcomes are diagnostic status and severity of the anxiety disorders, measured with The Anxiety Disorder Interview Schedule for DSM-IV, Parent and Child Versions. Secondary outcomes are parent and child ratings on questionnaires on the child’s level of anxiety and impact on everyday life. Additional outcomes entail information gathered from parents, child and teachers on the child’s behavior and negative self-statements, together with social and adaptive skills. Follow-up data will be collected 3 months after intervention. Discussion This study aims to evaluate the effectiveness of a manualized CBT program in Danish children with ASD and anxiety within a mental health clinic setting. The hypothesis is that training anxiety reduction skills will decrease anxiety in children, as well as ensure better psychosocial development for the child in general. Trial registration https://ClinicalTrials.gov (NCT02908321). Registered 19th of September 2016. Electronic supplementary material The online version of this article (10.1186/s13063-018-2591-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Tina R Kilburn
- Research Unit, Centre of Child and Adolescent Psychiatry, Aarhus University Hospital, Risskov, Denmark.
| | - Merete Juul Sørensen
- Unit C for School-aged Children, Centre of Child and Adolescent Psychiatry, Aarhus University Hospital, Risskov, Denmark
| | - Mikael Thastum
- Department of Psychology and Behavioural Science, Aarhus University, Aarhus, Denmark
| | - Ronald M Rapee
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia
| | - Charlotte Ulrikka Rask
- Research Unit & Unit C for School aged Children, Centre of Child and Adolescent Psychiatry, Aarhus University Hospital, Risskov, Denmark
| | - Kristian Bech Arendt
- Department of Psychology and Behavioural Science, Aarhus University, Aarhus, Denmark
| | - Per Hove Thomsen
- Centre of Child and Adolescent Psychiatry, Aarhus University Hospital, Risskov, Denmark
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Haugland BSM, Raknes S, Haaland AT, Wergeland GJ, Bjaastad JF, Baste V, Himle J, Rapee R, Hoffart A. School-based cognitive behavioral interventions for anxious youth: study protocol for a randomized controlled trial. Trials 2017; 18:100. [PMID: 28259171 PMCID: PMC5336667 DOI: 10.1186/s13063-017-1831-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Accepted: 02/08/2017] [Indexed: 11/29/2022] Open
Abstract
Background Anxiety disorders are prevalent among adolescents and may have long-lasting negative consequences for the individual, the family and society. Cognitive behavioral therapy (CBT) is an effective treatment. However, many anxious youth do not seek treatment. Low-intensity CBT in schools may improve access to evidence-based services. We aim to investigate the efficacy of two CBT youth anxiety programs with different intensities (i.e., number and length of sessions), both group-based and administered as early interventions in a school setting. The objectives of the study are to examine the effects of school-based interventions for youth anxiety and to determine whether a less intensive intervention is non-inferior to a more intensive intervention. Methods/design The present study is a randomized controlled trial comparing two CBT interventions to a waitlist control group. A total of 18 schools participate and we aim to recruit 323 adolescents (12-16 years). Youth who score above a cutoff on an anxiety symptom scale will be included in the study. School nurses recruit participants and deliver the interventions, with mental health workers as co-therapists and/or supervisors. Primary outcomes are level of anxiety symptoms and anxiety-related functional impairments. Secondary outcomes are level of depressive symptoms, quality of life and general psychosocial functioning. Non-inferiority between the two active interventions will be declared if a difference of 1.4 or less is found on the anxiety symptom measure post-intervention and a difference of 0.8 on the interference scale. Effects will be analyzed by mixed effect models, applying an intention to treat procedure. Discussion The present study extends previous research by comparing two programs with different intensity. A brief intervention, if effective, could more easily be subject to large-scale implementation in school health services. Trial registration ClinicalTrials.gov, NCT02279251. Registered on 15 October 2014. Retrospectively registered. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-1831-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Bente Storm Mowatt Haugland
- Regional Centre for Child and Youth Mental Health and Child Welfare, Uni Research Health, Pb 7810, 5020, Bergen, Norway.
| | - Solfrid Raknes
- Regional Centre for Child and Youth Mental Health and Child Welfare, Uni Research Health, Pb 7810, 5020, Bergen, Norway
| | - Aashild Tellefsen Haaland
- Clinic of Mental Health, Psychiatry and Addiction Treatment, Sorlandet Hospital HF, Kristiansand, Norway
| | - Gro Janne Wergeland
- Regional Centre for Child and Youth Mental Health and Child Welfare, Uni Research Health, Pb 7810, 5020, Bergen, Norway.,Department of Child and Adolescent Psychiatry, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Jon Fauskanger Bjaastad
- Regional Centre for Child and Youth Mental Health and Child Welfare, Uni Research Health, Pb 7810, 5020, Bergen, Norway.,Division of Psychiatry, Stavanger University Hospital, Stavanger, Norway
| | - Valborg Baste
- Regional Centre for Child and Youth Mental Health and Child Welfare, Uni Research Health, Pb 7810, 5020, Bergen, Norway
| | - Joe Himle
- Clinic of Mental Health, Psychiatry and Addiction Treatment, Sorlandet Hospital HF, Kristiansand, Norway.,Department of Psychiatry, University of Michigan, Ann Arbor, USA
| | - Ron Rapee
- Centre for Emotional Health, Macquarie University, Sydney, Australia
| | - Asle Hoffart
- Research Institute, Modum Bad Psychiatric Centre, Modum, Norway.,Department of Psychology, University of Oslo, Oslo, Norway
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