The impact of treatment delivery format on response to cognitive behaviour therapy for preadolescent children with anxiety disorders

Anna McKinnon; Robert Keers; Jonathan R I Coleman; Kathryn J Lester; Susanna Roberts; Kristian Arendt; Susan M Bögels; Peter Cooper; Cathy Creswell; Catharina A Hartman; Krister W Fjermestad; Tina In-Albon; Kristen Lavallee; Heidi J Lyneham; Patrick Smith; Richard Meiser-Stedman; Maaike H Nauta; Ronald M Rapee; Yasmin Rey; Silvia Schneider; Wendy K Silverman; Mikael Thastum; Kerstin Thirlwall; Gro Janne Wergeland; Thalia C Eley; Jennifer L Hudson

doi:10.1111/jcpp.12872

The impact of treatment delivery format on response to cognitive behaviour therapy for preadolescent children with anxiety disorders

J Child Psychol Psychiatry. 2018 Jul;59(7):763-772. doi: 10.1111/jcpp.12872. Epub 2018 Mar 9.

Authors

Anna McKinnon¹, Robert Keers², Jonathan R I Coleman^{3

4}, Kathryn J Lester⁵, Susanna Roberts³, Kristian Arendt⁶, Susan M Bögels⁷, Peter Cooper^{8

9

10}, Cathy Creswell⁸, Catharina A Hartman¹¹, Krister W Fjermestad^{12

13}, Tina In-Albon¹⁴, Kristen Lavallee¹⁵, Heidi J Lyneham¹, Patrick Smith¹⁶, Richard Meiser-Stedman¹⁷, Maaike H Nauta¹⁸, Ronald M Rapee¹, Yasmin Rey¹⁹, Silvia Schneider¹⁵, Wendy K Silverman²⁰, Mikael Thastum⁶, Kerstin Thirlwall⁸, Gro Janne Wergeland¹³, Thalia C Eley^{3

4}, Jennifer L Hudson¹

Affiliations

¹ Department of Psychology, Centre for Emotional Health, Macquarie University, Sydney, NSW, Australia.
² Department of Biological and Experimental Psychology, School of Biological and Chemical Sciences, Queen Mary University of London, London, UK.
³ Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
⁴ NIHR Biomedical Research Centre for Mental Health, South London and Maudsley NHS Trust, London, UK.
⁵ School of Psychology, University of Sussex, Brighton, UK.
⁶ Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark.
⁷ Research Institute Child Development and Education, University of Amsterdam, Amsterdam, The Netherlands.
⁸ School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK.
⁹ Department of Psychology, Stellenbosch University, Stellenbosch, South Africa.
¹⁰ Department of Psychology, The University of Cape Town, Cape Town, South Africa.
¹¹ Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
¹² Department of Clinical Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway.
¹³ Department of Child and Adolescent Psychiatry, Anxiety Disorders Research Network, Haukeland University Hospital, Bergen, Norway.
¹⁴ Department of Psychology, University Landau Koblenz, Landau, Germany.
¹⁵ Department of Psychology, Ruhr-Universität Bochum, Bochum, Germany.
¹⁶ Department of Psychology, Institute of Psychiatry, King's College London, London, UK.
¹⁷ Department of Psychology, University of East Anglia, Norwich, UK.
¹⁸ Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, The Netherlands.
¹⁹ Department of Psychology, Child Anxiety and Phobia Program, Florida International University, Miami, FL, USA.
²⁰ Child Study Center, School of Medicine, Yale University, New Haven, CT, USA.

Abstract

Background: Several delivery formats of cognitive behaviour therapy (CBT) for child anxiety have been proposed, however, there is little consensus on the optimal delivery format. The primary goal of this study was to investigate the impact of the child's primary anxiety diagnosis on changes in clinical severity (of the primary problem) during individual CBT, group CBT and guided parent-led CBT. The secondary goal was to investigate the impact of the child's primary anxiety diagnosis on rates of remission for the three treatment formats.

Methods: A sample of 1,253 children (5-12 years; Mage = 9.3, SD = 1.7) was pooled from CBT trials carried out at 10 sites. Children had a primary diagnosis of generalised anxiety disorder (GAD), social anxiety disorder (SoAD), specific phobia (SP) or separation anxiety disorder (SAD). Children and parents completed a semistructured clinical interview to assess the presence and severity of DSM-IV psychiatric disorders at preintervention, postintervention and follow-up. Linear mixture modelling was used to evaluate the primary research question and logistic modelling was used to investigate the secondary research question.

Results: In children with primary GAD, SAD or SoAD, there were no significant differences between delivery formats. However, children with primary SP showed significantly larger reductions in clinical severity following individual CBT compared to group CBT and guided parent-led CBT. The results were mirrored in the analysis of remission responses with the exception that individual CBT was no longer superior to group CBT for children with a primary SP. The difference between individual and group was not significant when follow-up data were examined separately.

Conclusions: Data show there may be greater clinical benefit by allocating children with a primary SP to individual CBT, although future research on cost-effectiveness is needed to determine whether the additional clinical benefits justify the additional resources required.

Keywords: Anxiety; cognitive therapy; treatment trials.

Publication types

Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Anxiety Disorders / therapy*
Anxiety, Separation / therapy
Child
Child, Preschool
Cognitive Behavioral Therapy / methods*
Female
Humans
Male
Outcome and Process Assessment, Health Care*
Parents*
Phobia, Social / therapy
Phobic Disorders / therapy
Psychotherapy, Group / methods*
Remission Induction
Severity of Illness Index

Supplementary concepts

Phobia, Specific

Abstract

Publication types

MeSH terms

Supplementary concepts

Grants and funding