Disorders - Anxiety Disorders
Balle, M., Tortella-Feliu, M.
Anxiety sensitivity (AS) is recognized as an
early risk factor for the development of anxiety disorders. This study evaluates whether a brief school-based selective prevention program reduces AS
and anxious and depressive symptoms in children and youth. Participants scoring high in AS but without any current psychopathological disorder were
selected from a sample of 613 individuals (61% female, 11-17 years old) and randomly assigned to the prevention program (n=47) or to a waiting-list
control (WLC) (n=45) group. A normal control (NC) group (n=53) was also included. After treatment, a significant decrease in AS and in anxiety and
depressive symptoms were observed in both prevention and WLC groups. Differences between experimental conditions only emerged, partially, at six-
month follow-up (FU) with the prevention group (PG) exhibiting significantly lower AS (p<.05), and equalling NCs. Although the magnitude of change in
the PG is comparable to that reported in previous studies with longer and more complex prevention programs, a parallel reduction in the WLCs suggests
that the observed decrease in the short term could be mostly time-linked. Despite this, our results encourage research into brief preventive
interventions at an individual level. (copyright) 2009 Taylor & Francis.
Anxiety, Stress & Coping, 23(1) : 71-
85
- Year: 2010
- Problem: Anxiety Disorders (any)
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions
(any), Other Psychological Interventions
Calear, Alison L., Christensen, Helen, Mackinnon, Andrew, Griffiths, Kathleen M., O'Kearney,
Richard
The aim in the current study was to investigate the
effectiveness of an online, self-directed cognitive–behavioral therapy program (MoodGYM) in preventing and reducing the symptoms of anxiety and
depression in an adolescent school-based population. A cluster randomized controlled trial was conducted with 30 schools (N = 1,477) from across
Australia, with each school randomly allocated to the intervention or wait-list control condition. At postintervention and 6-month follow-up,
participants in the intervention condition had significantly lower levels of anxiety than did participants in the wait-list control condition (Cohen
’s d = 0.15–0.25). The effects of the MoodGYM program on depressive symptoms were less strong, with only male participants in the intervention
condition exhibiting significant reductions in depressive symptoms at postintervention and 6-month follow-up (Cohen’s d = 0.27–0.43). Although
small to moderate, the effects obtained in the current study provide support for the utility of universal prevention programs in schools. The
effectiveness of booster sessions should be explored in future research. (PsycINFO Database Record (c) 2010 APA, all rights reserved) (journal
abstract)
Journal of Consulting & Clinical Psychology, 77(6) : 1021-
1032
- Year: 2009
- Problem: Anxiety Disorders (any), Depressive Disorders
- Type: Controlled clinical trials
-
Stage: Universal prevention
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions
(any), Cognitive & behavioural therapies (CBT), Technology, interventions delivered using technology (e.g. online, SMS)
Hunt, C., Andrews, G., Sakashita, C., Crino, R., Erskine, A.
Objective: To assess the effectiveness of an indicated early intervention and prevention programme for
anxiety disorders when conducted by school staff. Method: A total of 260 students in their first year of high school with self-reported anxiety
symptoms > 1 SD above the mean score of a normative sample were randomly allocated on the basis of their school to an intervention condition led by
school staff or to a monitoring condition. Results: There was little difference between conditions at the 2 year and 4 year follow up on self-
reported symptoms, and no difference on diagnosis or health-care use. Conclusions: Outcomes associated with indicated prevention programmes led by
school staff may not be as strong as those produced by specialist mental health staff. More work is needed to delineate models by which evidence-
based treatments can be effectively used in schools.
Australian & New Zealand Journal of Psychiatry, 43(4) : 300-
304
- Year: 2009
- Problem: Anxiety Disorders (any)
- Type: Controlled clinical trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions
(any), Other Psychological Interventions
Ginsburg, G. S.
The article presents the intervention model and primary outcomes of a preventive intervention designed
to reduce anxiety symptoms and prevent the onset of anxiety disorders in the offspring of parents with anxiety disorders. Participants were 40
volunteer children (mean age = 8.94 years; 45% girls; 90% Caucasian) whose parents met criteria for a broad range of anxiety disorders. Families were
randomly assigned to an 8-week cognitive-behavioral intervention, the Coping and Promoting Strength program (CAPS; n = 20) or a wait list control
condition (WL; n = 20). Independent evaluators (IEs) conducted diagnostic interviews, and children and parents completed measures of anxiety
symptoms. Assessments were conducted pre- and postintervention and 6 and 12 months after the postintervention assessment. On the basis of intent to
treat analyses, 30% of the children in the WL group developed an anxiety disorder by the 1-year follow-up compared with 0% in the CAPS group. IE and
parent-reported (but not child-reported) levels of anxiety showed significant decreases from the preintervention assessment to the 1-year follow-up
assessment in the CAPS but not the WL group. Parental satisfaction with the intervention was high. Findings suggest that a family-based intervention
may prevent the onset of anxiety disorders in the offspring of parents with anxiety disorders. (copyright) 2009 American Psychological
Association.
Journal of Consulting & Clinical Psychology, 77(3) : 580-
587
- Year: 2009
- 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)
Hudson, J. L., Rapee, R. M., Deveney, C., Schniering, C.
A., Lyneham, H. J., Bovopoulos, N.
OBJECTIVE:: 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. Copyright (copyright) 2009 American Academy of Child and Adolescent Psychiatry.
Journal of the American Academy of Child & Adolescent
Psychiatry, 48(5) : 533-544
- Year: 2009
- Problem: Anxiety Disorders (any)
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT)
Ipser, J. C., Stein, D. J., Hawkridge, S., Hoppe, L.
Background: Anxiety
disorders are a potentially disabling group of disorders which are prevalent in childhood and adolescence. The recognition of the early onset of
anxiety disorders, and their successful treatment with medication in adults, has led to the growing interest in using medication for paediatric
anxiety disorders. Objectives: To assess the efficacy and tolerability of medication for treating paediatric anxiety disorders. Search strategy: We
searched the Cochrane Depression, Anxiety & Neurosis Group specialised register (CCDANCTR-Studies), MEDLINE (via PubMed 1966 to August 2008), EMBASE
(1966 to August 2008), and PsycINFO (1972 to August 2008). Various electronic registers were searched for unpublished studies. Reference lists of
retrieved articles were searched for additional studies. Selection criteria: All randomised controlled trials (RCTs) of pharmacotherapy in
childhood/adolescent anxiety disorders. Data collection and analysis: Two raters independently assessed RCTs for inclusion in the review, collated
trial data, and assessed trial quality. Investigators were contacted to obtain missing data. Summary statistics were stratified by medication class,
and by medication agent for the selective serotonin reuptake inhibitors (SSRIs). Dichotomous and continuous measures were calculated using a random
effects model, heterogeneity was assessed, and subgroup/sensitivity analyses were undertaken. Main results: 22 short-term (<= 16 weeks) RCTs were
included in the analysis (2519 participants). The majority of the trials assessed the efficacy of the SSRIs (N = 15). Medication and placebo response
occurred in 58.1% and 31.5% of patients, respectively (Number of studies (N) = 14, Number needed to treat (NNT) = 4). Medication was more effective
than placebo in reducing overall symptom severity in OCD in a post-hoc comparison (N = 7, Weighted Mean Difference (WMD) = -4.45, 95%CI = -5.94, -
2.97, n = 765). Medication was less well tolerated than placebo overall, though the absolute proportion of participants who withdrew due to drug-
related adverse events was low (4.9%). Authors' conclusions: Medication treatments can be effective in paediatric anxiety disorders, acting to
reduce core symptoms, and should be considered as part of the treatment of these disorders. The greatest number of trials showing efficacy to date
have assessed the SSRIs in treating paediatric OCD. There is no clear evidence to show that any particular class of medication is more effective or
better tolerated than any other. As quantitative data was only available for the SSRIs and venlafaxine the routine use of benzodiazepines cannot be
recommended, especially given concerns of dependency and treatment -related emergent adverse events associated with this class of drugs. Future RCTs
could help identify potential clinical moderators of treatment efficacy. Studies of the long-term efficacy of medication treatment, optimal dosage,
as well as direct comparisons of pharmacotherapy and psychotherapy are also warranted. Copyright (copyright) 2009 The Cochrane Collaboration.
Published by John Wiley & Sons, Ltd.
Cochrane Database of Systematic Reviews, (3) :
- Year: 2009
- Problem: Anxiety Disorders (any)
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any)
Kraag, G., VanBreukelen, G. J. P., Kok, G., Hosman, C.
Background: This study examined the effects of a universal stress management program (Learn Young, Learn Fair) on stress, coping,
anxiety and depression in fifth and sixth grade children. Methods: Fifty-two schools (1467 children) participated in a clustered randomized
controlled trial. Data was collected in the fall of 2002, the spring of 2003, and the winter of 2004. Given the nested structure of the design mixed
(multilevel) regression analyses were applied. Results: Positive effects were found for emotion-focused coping at posttest (p <.01) and increased
stress awareness at both time points. At posttest a decrease in problem solving was found (p <.01). After correcting for mediation by stress
awareness the results showed that the program significantly reduced stress symptoms (p =.05) and anxiety (p =.01) at posttest. Effect sizes varied
from small to large. Conclusions: Universal prevention programs that address stress and coping in children are warranted given the high prevalence of
stress in children and the relationship between stress, on the one hand, and health complaints and pathology, on the other. Such programs are
expected to be particularly salient for children with an increased sensitivity to stress and inadequate coping styles (e.g., diathesis-stress model).
The results indicate that the school-based program 'Learn Young, Learn Fair' may be a valuable program for reducing stress in children. (copyright)
2009 Association for Child and Adolescent Mental Health.
Journal of Child Psychology & Psychiatry & Allied Disciplines, 50(9) : 1185-
1195
- Year: 2009
- Problem: Anxiety Disorders (any)
- Type: Controlled clinical trials
-
Stage: Universal prevention
-
Treatment and intervention: Psychological Interventions
(any), Other Psychological Interventions
Leong, Joyce, Cobham, Vanessa Elise, deGroot,
Jules, McDermott, Brett
Cognitive behavior therapy delivered by trained clinicians has been shown to be an
effective treatment for childhood anxiety. However, the prevalence of anxiety disorders in children and adolescents, combined with the practical and
psychological obstacles that often prevent families from accessing professional help, mean that alternative ways of reaching prospective clients must
be explored. This pilot study aims to compare the relative efficacy of two different modes of delivering a family-focused, cognitive-behavioral
intervention for children with an anxiety disorder. The two modalities compared were: a parent-delivered program (bibliotherapy) and a clinician-
delivered program (individual therapy). Twenty-seven children aged between 7 and 14, together with their parents, were randomly assigned to one of
the two conditions listed above. Results at post-treatment showed a significant improvement for children in both treatment conditions in terms of
diagnostic status, number of diagnoses and severity of primary diagnosis at follow-up. Children in the bibliotherapy condition demonstrated a
significant improvement over time in terms of child- and parent reported anxiety levels. No differences were found between the two treatment
conditions on any outcome measure. These results were maintained at 3- and 6-month follow-up. Although a pilot study, these data suggest that a
bibliotherapy format of the intervention described may have potential merit. The implications for service delivery are discussed, as are the
limitations of this research. (PsycINFO Database Record (c) 2010 APA, all rights reserved) (journal abstract)
European Child & Adolescent Psychiatry, 18(4) : 231-239
- Year: 2009
- Problem: Anxiety Disorders (any)
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT)
March, S., Spence, S.
H., Donovan, C. L.
OBJECTIVE: To evaluate the efficacy of an Internet-based cognitive-behavioral therapy (CBT) approach to the treatment of child
anxiety disorders. METHODS: Seventy-three children with anxiety disorders, aged 7-12 years, and their parents were randomly assigned to either an
Internet-based CBT (NET) or wait-list (WL) condition. Clinical diagnostic assessment and parent and child questionnaires were completed before and
after treatment. The NET condition was reassessed at 6-month follow-up. RESULTS: At posttreatment assessment, children in the NET condition showed
small but significantly greater reductions in anxiety symptoms and increases in functioning than WL participants. These improvements were enhanced
during the 6-month follow-up period, with 75% of NET children free of their primary diagnosis. CONCLUSIONS: Internet delivery of CBT for child
anxiety offers promise as a way of increasing access to treatment for this population. Future research is needed to examine ways to increase
treatment compliance and further enhance the impact of treatment.
Journal of Pediatric Psychology, 34(5) : 474-
487
- Year: 2009
- 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, interventions delivered using technology (e.g. online, SMS)
Neil, A. L., Christensen, H.
A systematic review was conducted of
school-based prevention and early intervention programs for anxiety. The aim of the review was to identify and describe the programs available, and
to evaluate their effectiveness in reducing symptoms of anxiety. Twenty-seven outcome trials, describing 20 individual programs, were identified
through the Cochrane Library, PsycInfo and PubMed databases. Results of the review indicated that most universal, selective and indicated prevention
programs are effective in reducing symptoms of anxiety in children and adolescents, with effect sizes ranging from 0.11 to 1.37. Most programs
targeted adolescents (59%), were aimed at reducing the symptoms of nonspecific anxiety (67%), and delivered cognitive behavioural therapy (CBT; 78%).
Further quality school-based research is required that involves longer-term follow-up, the use of attention control conditions and evaluates teacher
delivery. (copyright) 2009 Elsevier Ltd. All rights reserved.
Clinical Psychology Review, 29(3) : 208-
215
- Year: 2009
- Problem: Anxiety Disorders (any)
- Type: Systematic reviews
-
Stage: Universal prevention, At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions
(any)
Nevo, G. A., Manassis, K.
Background: Anxiety disorders are the most common psychiatric disorders of childhood, generating significant
distress in the individual and an economic burden to society. They are precursors to diverse psychiatric illnesses and have an impact on development.
Childhood anxiety's reach into the future accentuates the importance of studying the long-term effect of treatment. The purpose of this paper is to
examine existing Long-Term-Follow-Up (LTFU) studies' capacity to inform us on the impact of anxiety treatment on development. Method: Medline,
PsycInfo, SciSearch, SocScisearch, Cinhal, Embase, and the Cochrane library were searched. Bibliographies of relevant book chapters and review
articles and information from colleagues with expertise in anxiety were also a source of information. The search produced more than a thousand
citations. Only eight studies met inclusion criteria: follow-up of a cohort of treated anxious youth for more than 2 years. Results: followup ranged
from 2 to 7.4 years. The studies were methodologically rigorous and, in general, showed maintenance of or improvement in acute treatment gains. The
studies reviewed could not outline course of recovery or control for pivotal confounding variables such as maturation. Seven of the eight studies
employed a Cognitive Behavioral intervention and one employed a manualized, time-limited, psychodynamic intervention. No LTFU trial for medication
was found. Conclusion: ample evidence exists for the short-term benefit of pediatric anxiety treatment, but evidence is still lacking for the
understanding of treatment's role in the facilitation of healthy development into adulthood. Recommendations for future research are proposed.
(copyright) 2009 Wiley-Liss, Inc.
Depression & Anxiety, 26(7) : 650-660
- Year: 2009
- Problem: Anxiety Disorders (any)
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any)
Suveg, C., Hudson, J. L., Brewer, G., Flannery-Schroeder, E., Gosch, E., Kendall, P. C.
This study examined secondary outcomes of a randomized clinical trial that evaluated an
individual cognitive-behavioral (ICBT), family-based cognitive-behavioral (FCBT), and family-based education, support and attention (FESA) treatment
for anxious youth. Participants (161) were between 7 and 14 years (M = 10.27) of age and had a principal diagnosis of separation anxiety disorder,
social phobia, and/or generalized anxiety disorder. Hierarchical linear modeling examined youth-reported depressive symptomatology and parent- and
teacher-reported externalizing behavior and adaptive functioning at pretreatment, posttreatment, and 1-year follow-up. In general, youth in all
treatments evidenced improvements in most domains, with improvements maintained at follow-up. Overall, gender and age did not moderate treatment
outcomes. The results suggest that both child and family cognitive-behavioral therapy, and the family-based supportive approach used in this study,
can be effective in addressing some of the associated symptoms and adaptive functioning deficits typically linked to anxiety in youth. (copyright)
2009 Elsevier Ltd. All rights reserved.
Journal of Anxiety Disorders, 23(3) : 341-
349
- Year: 2009
- Problem: Anxiety Disorders (any)
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT)