Disorders - Anxiety Disorders
Spielmans, G. I., Pasek, L. F., McFall,
J. P.
Prior meta-analytic reviews have
indicated that cognitive and behavioral treatments are efficacious in treating child and adolescent depression and anxiety. Further, a meta-analysis
has suggested that behavioral treatments are superior to nonbehavioral treatments for treating anxiety and depression in youth. However, the prior
meta-analysis did not examine direct comparisons between cognitive and behavioral treatments (CBT) and non-CBT treatments, leaving open the
possibility that their results were artifactual. The present meta-analysis aggregated results of studies in which CBT treatments were compared with
either other bona fide treatments (including other CBT therapies) or non-bona fide therapies. The heterogeneity of the distribution of differences
between bona fide treatments as well as a comparison of full (e.g. CBT + Parent training) versus component treatments (e.g., CBT only) were examined.
The results indicated that: (a) CBT was more efficacious than non-bona fide therapies; (b) CBT was no more efficacious than bona fide non-CBT
treatments (c) the differences between bona fide treatments were homogenously distributed around zero; and (d) full CBT treatments offered no
significant benefit over their components. The results strongly suggest that the theoretically purported critical ingredients of CBT are not
specifically ameliorative for child and adolescent depression and anxiety. copyright 2007 Elsevier Ltd. All rights reserved.
Clinical Psychology Review., 27(5) : 642-
654
- Year: 2007
- Problem: Anxiety Disorders (any), Depressive Disorders
- Type: Systematic reviews
-
Stage: At risk (indicated or selected prevention), Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT)
Seligman, M. E. P., Schulman, P., Tryon, A.
M.
To prevent depression and anxiety, we delivered
a brief, classroom-based cognitive-behavioral workshop along with ongoing Web-based materials and e-mail coaching to college students at risk for
depression. At risk was defined as having mild to moderate depressive symptoms on a self-report measure of depression. Two hundred forty students
were randomized into either an eight-week workshop that met in groups of 10, once per week for 2 h or into an assessment-only control group. We plan
to track participants for 3 years after the workshop and here we report the 6 month preventive effects on depression and anxiety. The workshop group
had significantly fewer depressive symptoms and anxiety symptoms than the control group, but there was no significant difference between the
conditions on depression or anxiety episodes at 6 month follow up. The workshop group had significantly better well being than the control group, and
the workshop group had significantly greater improvement in optimistic explanatory style than the control group. Improved explanatory style was a
significant mediator of the prevention effects from pre- to post-workshop for depressive and anxiety symptoms, as well as for improved well being.
copyright 2006 Elsevier Ltd. All rights reserved.
Behaviour Research &
Therapy., 45(6) : 1111-1126
- Year: 2007
- Problem: Anxiety Disorders (any)
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions
(any), Cognitive & behavioural therapies (CBT), Technology, interventions delivered using technology (e.g. online, SMS)
Schmidt, N. B., Eggleston, A. M., Woolaway-Bickel, K., Fitzpatrick, K. K., Vasey, M. W., Richey, J. A.
Fear of arousal symptoms, often referred to as anxiety sensitivity (AS) appears to be associated with risk for anxiety pathology and other
Axis I conditions. Findings from a longitudinal prevention program targeting AS are reported. Participants (n = 404) scoring high on the Anxiety
Sensitivity Index (ASI) were randomly assigned to receive a brief intervention designed to reduce AS (Anxiety Sensitivity Amelioration Training
(ASAT)) or a control condition. Participants were followed for up to 24 months. Findings indicate that ASAT produced greater reductions in ASI levels
compared with the control condition. Moreover, reductions were specific to anxiety sensitivity relative to related cognitive risk factors for
anxiety. ASAT also produced decreased subjective fear responding to a 20% CO2 challenge delivered postintervention. Data from the follow-
up period show a lower incidence of Axis I diagnoses in the treated condition though the overall group difference was not statistically different at
all follow-up intervals. Overall, findings are promising for the preventative efficacy of a brief, computer-based intervention designed to decrease
anxiety sensitivity. copyright 2006 Elsevier Ltd. All rights reserved.
Journal of Anxiety Disorders., 21(3) : 302-319
- Year: 2007
- Problem: Anxiety Disorders (any)
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions
(any), Other Psychological Interventions
Spence, S. H., Holmes, J. M., March, S., Lipp, O. V.
Seventy-two clinically anxious children, aged 7 to 14 years, were
randomly allocated to clinic-based, cognitive-behavior therapy, the same treatment partially delivered via the Internet, or a wait-list control (WL).
Children in the clinic and clinic-plus-Internet conditions showed significantly greater reductions in anxiety from pre- to posttreatment and were
more likely to be free of their anxiety diagnoses, compared with the WL group. Improvements were maintained at 12-month follow-up for both therapy
conditions, with minimal difference in outcomes between interventions. The Internet treatment content was highly acceptable to families, with minimal
dropout and a high level of therapy compliance. Copyright 2006 by the American Psychological Association.
Journal of Consulting & Clinical
Psychology., 74(3) : 614-621
- Year: 2006
- 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)
Rapee, R. M., Abbott, M. J., Lyneham, H. J.
The current trial examined the value of modifying empirically
validated treatment for childhood anxiety for application via written materials for parents of anxious children. Two hundred sixty-seven clinically
anxious children ages 6-12 years and their parents were randomly allocated to standard group treatment, waitlist, or a bibliotherapy version of
treatment for childhood anxiety. In general, parent bibliotherapy demonstrated benefit for children relative to waitlist but was not as efficacious
as standard group treatment. Relative to waitlist, use of written materials for parents with no therapist contact resulted in around 15% more
children being free of an anxiety disorder diagnosis after 12 and 24 weeks. These results have implications for the dissemination and efficient
delivery of empirically validated treatment for childhood anxiety. Copyright 2006 by the American Psychological Association.
Journal of Consulting & Clinical Psychology., 74(3) : 436-444
- Year: 2006
- Problem: Anxiety Disorders (any)
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Self-help
Wood, J. J., Piacentini, J. C., Southam-Gerow, M., Chu, B. C., Sigman, M.
Objective: This study compared family-focused cognitive behavioral therapy (CBT; the Building Confidence
Program) with traditional child-focused CBT with minimal family involvement for children with anxiety disorders. Method: Forty clinically anxious
youth (6-13 years old) were randomly assigned to a family- or child-focused cognitive-behavioral therapy (CBT). Conditions were matched for therapist
contact time. Both interventions included coping skills training and in vivo exposure, but the family CBT intervention also included parent
communication training. Independent evaluator, parent, and child report measures with demonstrated validity and reliability were used to assess child
anxiety symptom outcomes at pre- and posttreatment. The data analytic strategy involved an evaluable patient analysis. Results: Compared with child-
focused CBT, family CBT was associated with greater improvement on independent evaluators' ratings and parent reports of child anxiety - but not
children's self-reports - at posttreatment. Conclusions: Both treatment groups showed improvement on all outcome measures, but family CBT may
provide additional benefit over and above child-focused CBT. These findings provide preliminary support for the efficacy of the \"Building
Confidence\" program and encourage further research in parental participation in treatment for childhood anxiety. copyright2006 by the American
Academy of Child and Adolescent Psychiatry.
Journal of the American Academy of Child & Adolescent Psychiatry., 45(3) : 314-
321
- Year: 2006
- Problem: Anxiety Disorders (any)
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT)
Lyneham, H. J., Rapee, R. M.
Supplementing bibliotherapy with therapist-client communication has been
shown to be an effective way of providing services to under-resourced and isolated communities. The current study examined the efficacy of
supplementing bibliotherapy for child anxiety disorders with therapist-initiated telephone or email sessions, or with client-initiated contact in a
randomised trial using a waitlist control. Participants were 100 anxiety-disordered children and their parents from rural and remote communities. All
treatment conditions resulted in improvement on self-report measures and clinician rated severity. Telephone sessions produced superior outcomes with
79% of children being anxiety disorder free post-treatment compared with 33% of email and 31% of client-initiated participants. The results suggest
that therapist supplemented bibliotherapy could provide an efficacious treatment option for families isolated from traditional treatment
services.
Behaviour Research &
Therapy, 44(9) : 1287-1300
- Year: 2006
- 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)
Larun, L., Nordheim, L. V., Ekeland, E., Hagen, K. B., Heian, F.
BACKGROUND: Depression and anxiety are common psychological
disorders for children and adolescents. Psychological (e.g. psychotherapy), psychosocial (e.g. cognitive behavioral therapy) and biological (e.g.
SSRIs or tricyclic drugs) treatments are the most common treatments being offered. The large variety of therapeutic interventions give rise to
questions of clinical effectiveness and side effects. Physical exercise is inexpensive with few, if any, side effects. OBJECTIVES: To assess the
effects of exercise interventions in reducing or preventing anxiety or depression in children and young people up to 20 years of age. SEARCH
STRATEGY: We searched the Cochrane Controlled Trials Register (latest issue available), MEDLINE, EMBASE, CINAHL, PsycINFO, ERIC and Sportdiscus up to
August 2005. SELECTION CRITERIA: Randomised trials of vigorous exercise interventions for children and young people up to the age of 20, with outcome
measures for depression and anxiety. DATA COLLECTION AND ANALYSIS: Two authors independently selected trials for inclusion, assessed methodological
quality and extracted data. The trials were combined using meta-analysis methods. A narrative synthesis was performed when the reported data did not
allow statistical pooling. MAIN RESULTS: Sixteen studies with a total of 1191 participants between 11 and 19 years of age were included.Eleven trials
compared vigourous exercise versus no intervention in a general population of children. Six studies reporting anxiety scores showed a non-significant
trend in favour of the exercise group (standard mean difference (SMD) (random effects model) -0.48, 95% confidence interval (CI) -0.97 to 0.01). Five
studies reporting depression scores showed a statistically significant difference in favour of the exercise group (SMD (random effects model) -0.66,
95% CI -1.25 to -0.08). However, all trials were generally of low methodological quality and they were highly heterogeneous with regard to the
population, intervention and measurement instruments used. One small trial investigated children in treatment showed no statistically significant
difference in depression scores in favour of the control group (SMD (fixed effects model) 0.78, 95% CI -0.47 to 2.04). No studies reported anxiety
scores for children in treatment.Five trials comparing vigorous exercise to low intensity exercise show no statistically significant difference in
depression and anxiety scores in the general population of children. Three trials reported anxiety scores (SMD (fixed effects model) -0.14, 95% CI -
0.41 to 0.13). Two trials reported depression scores (SMD (fixed effects model) -0.15, 95% CI -0.44 to 0.14). Two small trials found no difference in
depression scores for children in treatment (SMD (fixed effects model) -0.31, 95% CI -0.78 to 0.16). No studies reported anxiety scores for children
in treatment.Four trials comparing exercise with psychosocial interventions showed no statistically significant difference in depression and anxiety
scores in the general population of children. Two trials reported anxiety scores (SMD (fixed effects model) -0.13, 95% CI -0.43 to 0.17). Two trials
reported depression scores (SMD (fixed effects model) 0.10, 95% CI-0.21 to 0.41). One trial found no difference in depression scores for children in
treatment (SMD (fixed effects model) -0.31, 95% CI -0.97 to 0.35). No studies reported anxiety scores for children in treatment. AUTHORS'
CONCLUSIONS: Whilst there appears to be a small effect in favour of exercise in reducing depression and anxiety scores in the general population of
children and adolescents, the small number of studies included and the clinical diversity of participants, interventions and methods of measurement
limit the ability to draw conclusions. It makes little difference whether the exercise is of high or low intensity. The effect of exercise for
children in treatment for anxiety and depression is unknown as the evidence base is scarce. [References: 50]
Cochrane Database of Systematic
Reviews, 3 : CD004691
- Year: 2006
- Problem: Anxiety Disorders (any), Depressive Disorders
- Type: Systematic reviews
-
Stage: Universal prevention, At risk (indicated or selected prevention)
-
Treatment and intervention: Complementary & Alternative
Interventions (CAM), Physical activity, exercise
Gillham, J.
E., Reivich, K. J., Freres, D. R., Lascher, M., Litzinger, S., Shatte, A., Seligman, M. E.
Previous studies suggest that school-based
cognitive-behavioral interventions can reduce and prevent depressive symptoms in youth. This pilot study investigated the effectiveness of a
cognitive-behavioral depression prevention program, the Penn Resiliency Program for Children and Adolescents (the PRP-CA), when combined with a
parent intervention component. Forty-four middle school students and their parents were randomly assigned to the enhanced PRP (the PRP-CA plus parent
program) or control conditions. Students completed measures of depression and anxiety symptoms at baseline and 2 weeks, 6 months, and 1 year after
the intervention ended. The combined version of the PRP significantly reduced symptoms of depression and anxiety during the follow-up period.
Children assigned to the intervention condition were less likely than controls to report clinical levels of anxiety symptoms. Findings suggest that
school-based cognitive-behavioral interventions that include parents may prevent depression and anxiety symptoms in early adolescence. (PsycINFO
Database Record (c) 2012 APA, all rights reserved)
School Psychology Quarterly, 21(3) : 323-48
- Year: 2006
- Problem: Anxiety Disorders (any), Depressive Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions
(any), Other Psychological Interventions
Bernstein, G. A., Layne, A. E., Egan, E. A., Tennison, D.
M.
Objective: To compare the effectiveness of three school-based interventions for anxious children: group cognitive-behavioral therapy (CBT)
for children, group CBT for children plus parent training group, and no-treatment control. Method: Students (7-11 years old) in three elementary
schools (N = 453) were screened using the Multidimensional Anxiety Scale for Children and teacher nomination. Subsequently, 101 identified children
and their parents completed the Anxiety Disorders Interview Schedule for DSM-IV, Child Version. Children with features or DSM-IV diagnoses of
separation anxiety disorder, generalized anxiety disorder, and/or social phobia (n = 61) were randomized by school to one of three conditions. Active
treatments were nine weekly sessions of either group CBT or group CBT plus concurrent parent training. Results: Clinician-report, child-report, and
parent-report measures of child anxiety demonstrated significant benefits of CBT treatments over the no-treatment control group. Effect size was 0.58
for change in composite clinician severity rating, the primary outcome measure, favoring collapsed CBT conditions compared with control. In addition,
several instruments showed significantly greater improvement in child anxiety for group CBT plus parent training over group CBT alone. Conclusions:
Both active CBT treatments were more effective than the no-treatment control condition in decreasing child anxiety symptoms and associated
impairment. When parent training was combined with child group CBT, there were some additional benefits for the children. copyright2005 by the
American Academy of Child and Adolescent Psychiatry.
Journal of the American Academy of Child & Adolescent Psychiatry, 44(11) : 1118-
1127
- Year: 2005
- Problem: Anxiety Disorders (any), Generalized Anxiety Disorder, Social phobia (social anxiety disorder)
- Type: Controlled clinical trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT), Other Psychological Interventions
Clark,
Duncan B., Birmaher, Boris, Axelson, David, Monk, Kelly, Kalas, Catherine, Ehmann, Mary, Bridge, Jeffrey, Wood, Scott, Muthen,
Bengt, Brent, David
Objective: To assess the efficacy of fluoxetine for the long-term treatment of children and adolescents with anxiety disorders,
including generalized anxiety disorder, separation anxiety disorder, and/or social phobia. Method: Children and adolescents (7-17 years old) with
anxiety disorders were studied in open treatment for 1 year after they completed a randomized, controlled trial (RCT) comparing fluoxetine and
placebo. The follow-up phase assessments included clinician, parent, and child ratings with measures of global severity, global improvement, and
anxiety symptoms. Results: Subjects taking fluoxetine (n = 42) were compared with those taking no medication (n = 10) during follow-up on anxiety
changes from the end of the RCT through the follow-up period. Statistical models included RCT assignment and follow-up psychological treatment.
Excluded subjects took other medications (n = 4) or did not complete follow-up (n = 18). Compared with subjects taking no medication, subjects taking
fluoxetine showed significantly superior follow-up outcomes on most measures, including clinician, parent, and child ratings. Conclusions: The
results suggest that fluoxetine is clinically effective for the maintenance treatment of anxiety disorders in children and adolescents. A major
limitation, however, was the lack of RCT methodology in the follow-up phase. RCTs are needed to determine the long-term risks and benefits of
fluoxetine for this group. (PsycINFO Database Record (c) 2008 APA, all rights reserved) (journal abstract).
Journal of the American Academy of Child & Adolescent
Psychiatry, 44(12) : 1263-1270
- Year: 2005
- Problem: Anxiety Disorders (any)
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Selective serotonin reuptake inhibitors (SSRIs)
Rapee, Ronald M., Kennedy, Susan, Ingram, Michelle, Edwards, Susan, Sweeney, Lynne
This article reports results from an early intervention program aimed at
preventing the development of anxiety in preschool children. Children were selected if they exhibited a high number of withdrawn/inhibited
behaviors--one of the best identified risk factors for later anxiety disorders--and were randomly allocated to either a 6-session parent-education
program or no intervention. The education program was group based and especially brief to allow the potential for public health application. Children
whose parents were allocated to the education condition showed a significantly greater decrease in anxiety diagnoses at 12 months relative to those
whose parents received no intervention. However, there were no significant effects demonstrated on measures of inhibition/withdrawal. The results
demonstrate the value of (even brief) very early intervention for anxiety disorders, although these effects do not appear to be mediated through
alterations of temperament. (c) 2005 APA, all rights reserved.
Journal of Consulting & Clinical Psychology, 73(3) : 488-97
- Year: 2005
- Problem: Anxiety Disorders (any)
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions
(any), Psychoeducation