Disorders - Anxiety Disorders
Zalta, Alyson K.
This meta-analysis assessed efficacy of cognitive-behavioral
interventions in preventing anxiety symptoms. A systematic review identified 15 independent pretest-posttest randomized or quasi-randomized efficacy
trials for analysis. At posttest, intervention groups demonstrated significantly greater symptom reduction compared to control groups resulting in
weighted mean effect sizes (Hedges' g) of 0.25 for general anxiety, 0.24 for disorder-specific symptoms, and 0.22 for depression after the removal
of outliers. These effects appeared to diminish over 6- and 12-month follow-up. Exploratory moderator analyses indicated that individually
administered media interventions were more effective than human-administered group interventions at preventing general anxiety and depression
symptoms. Implications of current findings are discussed with attention to existing gaps in the literature.
Journal of Anxiety Disorders, 25(5) : 749-
760
- Year: 2011
- Problem: Anxiety Disorders (any)
- Type: Systematic reviews
-
Stage: Universal prevention, At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT)
Ronsley, R., Elbe, D., Smith, D. H., Garland, E. J.
Objectives: 1) To review SSRI prescribing patterns for children and adolescents in our hospital and
provincial prescription database and 2) To evaluate whether prescribing practices are consistent with expectations, based on published evidence and
practice recommendations. Methods: A PubMed online search was conducted to obtain all randomized controlled trials assessing efficacy of SSRI use in
children and adolescents. The inpatient hospital pharmacy database at BC Children's Hospital (BCCH) and the BC Pharmacare database were used to
identify all unique patients (under 19 years of age) seen in the inpatient department of psychiatry at BCCH or as outpatients in the province of BC
receiving SSRI prescriptions between 2005-2009. Results: Fluoxetine, citalopram, escitalopram and sertraline have evidence supporting their efficacy
in the treatment of depressive disorders. Fluoxetine, fluvoxamine, sertraline, paroxetine and venlafaxine have evidence for use in the treatment of
anxiety disorders. Between 2005-2009, BCCH inpatient data revealed that fluoxetine is the most frequently prescribed SSRI, followed by citalopram,
sertraline, fluvoxamine, venlafaxine, paroxetine and escitalopram. In the community outpatients, fluoxetine was most frequently prescribed SSRI
followed by citalopram, venlafaxine, sertraline, paroxetine, fluvoxamine and escitalopram. Conclusions: Prescribing patterns for SSRIs at BC
Children's Hospital are consistent with the available evidence in the pediatric population. Furthermore, with the exception of citalopram,
provincial outpatient and inpatient prescriptions appear to follow published national guidelines. Hospital SSRI usage more closely reflects the
available literature than outpatient community usage does. (copyright) Canadian Academy of Child and Adolescent Psychiatry.
Journal of the Canadian Academy of Child & Adolescent Psychiatry, 19(3) : 218-226
- Year: 2010
- Problem: Anxiety Disorders (any)
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Selective serotonin reuptake inhibitors (SSRIs)
Wolitzky-Taylor, K. B., Telch, M. J.
Research on treatments for reducing pathological worry is limited. In particular, academic worry is a common theme in generalized
anxiety disorder (GAD) samples as well as non-clinical student samples. Given the high cost of anxiety disorders to society, research is needed to
examine the efficacy of self-administered treatments designed to reduce pathological worry. The primary goal of this study was to investigate the
benefits of three self-administered interventions for reducing academic worry. College students (N = 113) experiencing clinically significant
academic worry were randomized to either: (a) worry exposure (WE); (b) expressive writing (EW); (c) relaxation consisting of pulsed audio-photic
stimulation (APS); or (d) waitlist control (WLC). Participants were instructed to practice their interventions three times per week for one month and
completed home practice logs online to track treatment adherence. Academic worry, general anxiety, and perceived stress were assessed at baseline and
post-treatment. Academic worry and general anxiety were also assessed at a three-month follow-up. Those assigned to the WE and APS conditions showed
significant improvement relative to EW and WLC at post-treatment. All treatment conditions showed continued improvement by follow-up, with no
between-group differences. Treatment and public health implications are discussed. © 2010 Elsevier Ltd.
Behaviour Research and Therapy, 48(9) : 840-850
- Year: 2010
- Problem: Anxiety Disorders (any)
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Complementary & Alternative
Interventions (CAM), Psychological Interventions
(any), Exposure therapy, Exposure
and response prevention, Creative expression: music, dance, drama, art, Relaxation
Southam-Gerow, M. A., Weisz, J. R., Chu, B. C., McLeod,
B. D., Gordis, E. B., Connor-Smith, J. K.
Objective: Most tests of cognitive behavioral
therapy (CBT) for youth anxiety disorders have shown beneficial effects, but these have been efficacy trials with recruited youths treated by
researcher-employed therapists. One previous (nonrandomized) trial in community clinics found that CBT did not outperform usual care (UC). The
present study used a more stringent effectiveness design to test CBT versus UC in youths referred to community clinics, with all treatment provided
by therapists employed in the clinics. Method: A randomized controlled trial methodology was used. Therapists were randomized to training and
supervision in the Coping Cat CBT program or UC. Forty-eight youths (56% girls, 8 to 15 years of age, 38% Caucasian, 33% Latino, 15% African-
American) diagnosed with DSM-IV anxiety disorders were randomized to CBT or UC. Results: At the end of treatment more than half the youths no longer
met criteria for their primary anxiety disorder, but the groups did not differ significantly on symptom (e.g., parent report, eta-square = 0.0001;
child report, eta-square = 0.09; both differences favoring UC) or diagnostic (CBT, 66.7% without primary diagnosis; UC, 73.7%; odds ratio 0.71)
outcomes. No differences were found with regard to outcomes of comorbid conditions, treatment duration, or costs. However, youths receiving CBT used
fewer additional services than UC youths ((chi)21 = 8.82, p = .006). Conclusions: CBT did not produce better clinical outcomes than usual community
clinic care. This initial test involved a relatively modest sample size; more research is needed to clarify whether there are conditions under which
CBT can produce better clinical outcomes than usual clinical care.
Journal of the American Academy of Child & Adolescent Psychiatry, 49(10) : 1043-
1052
- Year: 2010
- Problem: Anxiety Disorders (any), Generalized Anxiety Disorder, Social phobia (social anxiety disorder), Specific
Phobia
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT)
Uthman, O. A., Abdulmalik, J.
OBJECTIVE: to compare efficacy and
acceptability of different pharmacotherapeutic agents for treating anxiety disorders in children and adolescents. METHODS: A recently conducted
Cochrane Review on pharmacotherapy for anxiety disorders in children and adolescents was updated. A mixed treatment comparison meta-analysis using
Bayesian Markov Chain Monte Carlo simulation was used to perform the indirect comparison. We calculated relative risk ratios (RR) with 95% credible
interval (CrI) using placebo as the common comparator. RESULTS: Data were combined from 16 clinical trials that randomized children to six different
treatment strategies, including placebo. Fluoxetine, fluvoxamine, paroxetine, sertraline, and venlafaxine were more efficacious than placebo.
Venlafaxine was significantly less efficacious than fluvoxamine (RR = 0.60; 95% CrI 0.35-0.95) and paroxetine (RR = 0.65; 95% CrI 0.44-0.93).
Fluoxetine, fluvoxamine, paroxetine, and sertraline had higher acceptability profile than placebo. Venlafaxine was less tolerated than fluvoxamine
(RR = 0.16; 95% CrI 0.01-0.64), paroxetine (RR = 0.21; 95% CrI 0.05-0.59), and sertraline (RR = 0.31; 95% CrI 0.08-0.83). Fluvoxamine had a higher
rate of clinical response and acceptability compared to other treatments in the network, with probability of 47.5% and 50.6% of being the most
efficacious and well-tolerated treatment, respectively. CONCLUSION: Clinically important differences exist between commonly prescribed
pharmacotherapeutic agents for treating anxiety among children in terms of both efficacy and acceptability in favor of fluvoxamine. Fluvoxamine might
be the best choice when starting treatment for anxiety disorders among children and adolescents because it has the most favorable balance between
benefits and acceptability.
Current Medical
Research & Opinion, 26(1) : 53-59
- Year: 2010
- Problem: Anxiety Disorders (any)
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Selective serotonin reuptake inhibitors (SSRIs), Serotonin-norepinephrine reuptake inhibitors
(SNRIs)
Roberts, C. M., Kane, R., Bishop, B., Cross, D., Fenton, J., Hart, B.
A randomised controlled trial evaluated the Aussie Optimism Program in preventing anxiety and depression. Grade 7 students (n = 496)
from disadvantaged government schools in Perth Western Australia, participated. Six schools were randomly assigned to Aussie Optimism and six schools
received their usual health education lessons. Students completed questionnaires on depression, anxiety, attribution style, and social skills.
Parents completed the Child Behavior Checklist. No significant group effects were found for student-reported data. Parents of intervention group only
students reported reductions in internalizing problems at post-test. No follow-up group effects were significant. Students and teachers found the
program acceptable. Crown Copyright (copyright) 2009.
Behaviour Research & Therapy, 48(1) : 68-73
- Year: 2010
- Problem: Anxiety Disorders (any), Depressive Disorders
- Type: Controlled clinical trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions
(any), Psychoeducation, Skills training
Saavedra,
L. M., Silverman, W. K., Morgan-Lopez, A. A., Kurtines, W. M.
The present study's aim was to
examine the long-term effects (8 to 13 years post-treatment; M = 9.83 years; SD = 1.71) of the most widely used treatment approaches of exposure-
based cognitive behavioral treatment for phobic and anxiety disorders in children and adolescents (i.e., group treatment and two variants of
individual treatment). An additional aim was to compare the relative long-term efficacy of the treatment approaches. At long-term follow-up,
participants (N = 67) were between 16 and 26 years of age (M = 19.43 years, SD = 3.02). Primary outcome was the targeted anxiety disorder and
targeted symptoms. Secondary outcomes were other disorders and symptoms not directly targeted in the treatments including (1) other anxiety disorders
and symptoms, (2) depressive disorders and symptoms, and (3) substance use disorders and symptoms. Long-term remission for anxiety disorders and
symptoms targeted in the treatments was evident 8 to 13 years post-treatment. Long-term remission also was found for the secondary outcomes. There
were more similarities than differences in the long-term gains when comparing the treatment approaches. Consistent with past research, the study's
findings provide further evidence that the short-term benefits of exposure-based CBT for childhood phobic and anxiety disorders using both group and
individual treatment may extend into the critical transition years of young adulthood.
Journal of Child Psychology &
Psychiatry & Allied Disciplines, 51(8) : 924-934
- Year: 2010
- Problem: Anxiety Disorders (any)
- Type: Controlled clinical trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT)
Richardson, Thomas, Stallard, Paul, Velleman, Sophie
Research has shown that computerised cognitive behaviour therapy (cCBT) can be effective in the treatment of depression and anxiety in
adults, although the outcomes with children and adolescents are unclear. The aim of the study is to systematically review the literature on the
effectiveness of cCBT for the prevention and treatment of depression and anxiety in children and adolescents. EMBASE, PsycINFO and Pubmed were
searched using specific terms and inclusion criteria for cCBT studies involving young people under the age of 18. A hand search was also conducted,
and the authors were contacted to identify additional papers. Ten studies met the inclusion criteria. These included case series and randomised
controlled trials concerned with both treatment and prevention. Six different software packages were described that varied in length and the nature
and extent of professional contact and supervision. All studies reported reductions in clinical symptoms and also improvements in variables such as
behaviour, self-esteem and cognitions. Satisfaction with treatment was moderate to high from both children and parents, though levels of drop out and
non-completion were often high. Additional randomised controlled trials are required, as the literature is currently limited. However, preliminary
evidence suggests that cCBT is an acceptable and effective intervention for this age group. (PsycINFO Database Record (c) 2010 APA, all rights
reserved) (journal abstract)
Clinical Child & Family Psychology Review, 13(3) : 275-
290
- Year: 2010
- Problem: Anxiety Disorders (any), Depressive Disorders
- Type: Systematic reviews
-
Stage: Universal prevention, At risk (indicated or selected prevention), Disorder established (diagnosed disorder)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions
(any), Cognitive & behavioural therapies (CBT), Technology, interventions delivered using technology (e.g. online, SMS)
Tomba, E., Belaise, C., Ottolini, F., Ruini, C., Bravi, A., Albieri, E., Rafanelli, C., Caffo, E., Fava, G. A.
The aim of the present study was to examine the differential effects of
strategies for promotion of psychological well-being (Well-Being Therapy, WBT) and removal of distress (Anxiety Management, AM) in a non-clinical
school setting.162 students attending middle schools in Northern Italy were randomly assigned to: (a) a protocol derived from WBT; (b) an anxiety-
management protocol (AM). The students were assessed immediately before and after the interventions, and after 6 months using: Psychological Well-
Being Scales (PWB), Symptom Questionnaire (SQ) and the Revised Children's Manifest Anxiety Scale (RCMAS). In school children, well-being and symptom
focused interventions produced slightly different effects on psychological dimensions. WBT, by facilitating progression toward positive and optimal
functioning, may integrate symptom-centered strategies. (copyright) 2010 Elsevier Ltd.
Journal of Anxiety Disorders, 24(3) : 326-333
- Year: 2010
- Problem: Anxiety Disorders (any)
- Type: Controlled clinical trials
-
Stage: Universal prevention
-
Treatment and intervention: Psychological Interventions
(any), Psychoeducation
Olatunji, Bunmi O., Cisler, Josh M., Tolin, David F.
Although psychiatric comorbidity is common among patients with anxiety
disorders, its impact on treatment outcome remains unclear. The present study used meta-analytic techniques to examine the relationship between
diagnostic comorbidity and treatment outcome for patients with anxiety disorders. One hundred forty-eight anxiety-disordered treatment samples
(combined N=3534) were examined for post-treatment effects from the PsychINFO database. Samples consisted of those exposed to both active (CBT,
dynamic therapy, drug treatment, CBT+drug treatment, mindfulness) and inactive treatments (placebo/attention control, wait-list). All treatments were
associated with significant improvement at post-treatment, and active treatments were associated with greater effects than were inactive treatments.
However, overall comorbidity was generally unrelated to effect size at post-treatment or at follow-up. A significant negative relationship between
overall comorbidity and treatment outcome was found for mixed or \"neurotic\" anxiety samples when examining associations between comorbidity and
specific diagnoses. Conversely, there was a significant positive relationship between overall comorbidity and treatment outcome for panic disorder
and/or agoraphobia and PTSD or sexual abuse survivors. These findings suggest that while diagnostic comorbidity may not impact the effects of
specific anxiety disorder treatments, it appears to differentially impact outcome for specific anxiety disorder diagnoses.\rCopyright 2010 Elsevier
Ltd. All rights reserved.
Clinical Psychology Review, 30(6) : 642-
654
- Year: 2010
- Problem: Anxiety Disorders (any)
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Psychological Interventions
(any)
Khanna, M. S., Kendall, P. C.
Objective: This study examined the feasibility, acceptability, and effects
of Camp Cope-A-Lot (CCAL), a computer-assisted cognitive behavioral therapy (CBT) for anxiety in youth. Method: Children (49; 33 males) ages 7-13 (M
= 10.1 (plus or minus) 1.6; 83.7 Caucasian, 14.2 African American, 2 Hispanic) with a principal anxiety disorder were randomly assigned to (a) CCAL,
(b) individual CBT (ICBT), or (c) a computer-assisted education, support, and attention (CESA) condition. All therapists were from the community
(school or counseling psychologists, clinical psychologist) or were PsyD or PhD trainees with no experience or training in CBT for child anxiety.
Independent diagnostic interviews and self-report measures were completed at pre- and posttreatment and 3-month follow-up. Results: At posttreatment,
ICBT or CCAL children showed significantly better gains than CESA children; 70, 81, and 19, respectively, no longer met criteria for their principal
anxiety diagnosis. Gains were maintained at follow-up, with no significant differences between ICBT and CCAL. Parents and children rated all
treatments acceptable, with CCAL and ICBT children rating higher satisfaction than CESA children. Conclusions: Findings support the feasibility,
acceptability and beneficial effects of CCAL for anxious youth. Discussion considers the potential of computer-assisted treatments in the
dissemination of empirically supported treatments. (copyright) 2010 American Psychological Association.
Journal of Consulting & Clinical
Psychology, 78(5) : 737-745
- Year: 2010
- Problem: Anxiety Disorders (any)
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions
(any), Cognitive & behavioural therapies (CBT), Technology, comparing delivery mode (e.g. online vs. face-to-face)
Manassis, K., Wilansky-Traynor, P., Farzan, N., Kleiman, V., Parker, K., Sanford, M.
Children with anxious or depressive
symptoms are at risk of developing internalizing disorders and their attendant morbidity. To prevent these outcomes, school-based cognitive-
behavioral therapy (CBT) has been developed, but few studies include active control conditions. We evaluated a preventive CBT program targeting
internalizing symptoms relative to an activity contrast condition post-intervention and at 1-year follow-up. One thousand one hundred and thirty-nine
children from Grades 3-6 from a diverse sample of schools, were screened with the Multidimensional Anxiety Scale for Children and Children's
Depression Inventory. Those with t>60 on either measure were offered participation in a randomized 12-week trial, school-based group CBT versus a
structured after-school activity group of equal duration. We explored several therapeutic elements as potential predictors of change. One hundred and
forty-eight children participated (84 boys, 64 girls; 78 CBT, 70 contrast; 57% Caucasian) and 145 completed the program. Self-reported anxious and
depressive symptoms decreased significantly over time ((eta)(2)=.15 and .133, respectively), with no group by time interaction. There was a trend
toward fewer children meeting diagnostic criteria for an anxiety disorder on the Anxiety Disorders Interview Schedule at 1-year post-CBT than post-
contrast (6/76 versus 12/69). Positive reinforcement of child behavior was associated with change in anxiety symptoms; checking homework was
understood with change in depressive symptoms. Findings suggest that children with internalizing symptoms may benefit from both school-based CBT and
structured activity programs. Replication, longer follow-up, and further studies of therapeutic elements in child CBT are indicated. ISRCTN Registry
identifier: ISRCTN88858028, url: http://www.controlled-trials.com/. Depression and Anxiety, 2010. (copyright) 2010 Wiley-Liss, Inc.
Depression & Anxiety, 27(10) : 945-
952
- Year: 2010
- Problem: Anxiety Disorders (any)
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT)