Disorders - Anxiety Disorders
Scott, R. W., Mughelli, K., Deas, D.
Objective:
Although several treatments for children and adolescents with anxiety disorders are available, there are few well-controlled studies in the
literature that compare these treatments for efficacy. The objective of this paper is to provide an overview of controlled treatment studies for
children and adolescents with anxiety disorders. Method: The research literature on controlled treatment studies of anxiety disorders in children and
adolescents was systematically reviewed through a search of PsycINFO and Medline. Studies that did not compare the efficacy of treatment modalities
were excluded. Results: This review focuses specifically on three main treatment modalities: cognitive-behavioral therapy, both individual and group;
family-based interventions; and pharmacotherapy. Each of these modalities is reviewed in the context of the separate disorders as defined by DSM-
III-R and/or DSM-IV. The results are especially promising for cognitive-behavioral therapy and pharmacotherapy for many of the anxiety disorders;
however, there are concerns about small sample sizes, lack of described comorbidity within the groups and generalizability. Conclusion: While great
strides have been made in the treatment of child and adolescent anxiety disorders, empirically based studies are quantitatively limited. More
research is needed involving head-to-head trials of the different modalities.
Journal of the National Medical Association., 97(1) : 13-
24
- Year: 2005
- Problem: Anxiety Disorders (any)
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Psychological Interventions
(any)
Siqueland,
L., Rynn, M., Diamond, G. S.
The goals of these two studies were to assess the
acceptability and feasibility as well as to gather preliminary efficacy data on a modified combination cognitive behavioral (CBT) and attachment
based family therapy (ABFT) for adolescents (ages 12-18), with the primary diagnosis of generalized (GAD), social phobia (SP), and separation (SAD)
anxiety disorders. In Phase I, CBT was modified for an adolescent population and ABFT was modified for working with anxious adolescents in
combination with CBT. Therapists were trained for both conditions and eight patients were treated as an open trial pilot of combined CBT-ABFT with
positive results. In Phase II, 11 adolescents were randomly assigned to CBT alone or CBT and family based treatment (CBT-ABFT). Participants were
evaluated at pre, post, and 6-9 months follow-up assessing diagnosis, psychiatric symptoms and family functioning. Results indicated significant
decreases in anxiety and depressive symptoms by both clinical evaluator and self-reports with no significant differences by treatment. Sixty-seven
percent of adolescents in CBT no longer met criteria for their primary diagnosis at post treatment as compared to 40% in CBT-ABFT with continued
improvement of 100 and 80% at follow-up with no significant differences between treatments. Both CBT and CBT-ABFT appear to be promising treatments
for anxious adolescents and more treatment development and evaluation is needed. copyright 2004 Elsevier Inc. All rights reserved.
Journal of Anxiety Disorders., 19(4) : 361-
381
- Year: 2005
- Problem: Anxiety Disorders (any), Social phobia (social anxiety disorder)
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT), Family therapy
Jaberghaderi, N., Greenwald,
R., Rubin, A., Zand, S. O., Dolatabadi, S.
Fourteen randomly assigned Iranian girls ages 12 - 13 years who
had been sexually abused received up to 12 sessions of CBT or EMDR treatment. Assessment of post-traumatic stress symptoms and problem behaviours was
completed at pre-treatment and 2 weeks post-treatment. Both treatments showed large effect sizes on the post-traumatic symptom outcomes, and a medium
effect size on the behaviour outcome, all statistically significant. A non-significant trend on self-reported post-traumatic stress symptoms favoured
EMDR over CBT. Treatment efficiency was calculated by dividing change scores by number of sessions; EMDR was significantly more efficient, with large
effect sizes on each outcome. Limitations include small N, single therapist for each treatment condition, no independent verification of treatment
fidelity, and no long-term follow-up. These findings suggest that both CBT and EMDR can help girls to recover from the effects of sexual abuse, and
that structured trauma treatments can be applied to children in Iran.
Clinical Psychology & Psychotherapy, 11(5) : 358-
368
- Year: 2004
- Problem: Anxiety Disorders (any), Post Traumatic Stress Disorder
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT), Eye movement desensitisation and reprocessing (EMDR)
Compton, Scott N., March, John
S., Brent, David, Albano, Anne Marie, Weersing, Robin, Curry, John
OBJECTIVE: To review the literature on the
cognitive-behavioral treatment of children and adolescents with anxiety and depressive disorders within the conceptual framework of evidence-based
medicine. METHOD: The psychiatric and psychological literature was systematically searched for controlled trials applying cognitive-behavioral
treatment to pediatric anxiety and depressive disorders. RESULTS: For both anxiety and depression, substantial evidence supports the efficacy of
problem-specific cognitive-behavioral interventions. Comparisons with wait-list, inactive control, and active control conditions suggest medium to
large effects for symptom reduction in primary outcome domains. CONCLUSIONS: From an evidence-based perspective, cognitive-behavioral therapy is
currently the treatment of choice for anxiety and depressive disorders in children and adolescents. Future research in this area will need to focus
on comparing cognitive-behavioral psychotherapy with other treatments, component analyses, and the application of exportable protocol-driven
treatments to divergent settings and patient populations. [References: 80]
Journal of the American Academy of Child & Adolescent Psychiatry, 43(8) : 930-
59
- Year: 2004
- Problem: Anxiety Disorders (any), Depressive Disorders
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT)
Cartwright-Hatton, Sam, Roberts, Chris, Chitsabesan, Prathiba, Fothergill, Claire, Harrington, Richard
PURPOSE: To review the
effectiveness of cognitive behaviour therapy (CBT) as a treatment for anxiety disorders of childhood and adolescence. METHOD: Studies were included
if they treated young people (under 19 yrs) with diagnosed anxiety disorder (excluding trials solely treating phobia, PTSD or OCD), had a no-
treatment control group, and used diagnosis as an outcome variable. A search of the literature, incorporating electronic databases, hand search and
expert consultation, yielded 10 randomized controlled trials that were appropriate for inclusion. RESULTS: The outcome of interest was remission of
anxiety disorder. Employing conservative criteria, the remission rate in the CBT groups (56.5%) was higher than that in the control groups (34.8%).
The pooled odds ratio was 3.3 (CI = 1.9-5.6), suggesting that CBT has a significant effect. CONCLUSIONS: CBT is useful for the treatment of anxiety
in children over the age of 6 years. However, we still know little about the treatment of younger children or about the comparative efficacy of
alternative treatments. Most of the trials were efficacy trials, and have limited generalizability. Reporting of many aspects of the trials was weak.
[References: 33]
British Journal of Clinical Psychology, 43(Pt 4) : 421-
36
- Year: 2004
- Problem: Anxiety Disorders (any)
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT)
Broman-Fulks, JJ., Berman, ME., Rabian, BA., Webster, MJ.
Anxiety sensitivity is a known precursor to panic attacks and panic
disorder, and involves the misinterpretation of anxiety-related sensations. Aerobic exercise has been shown to reduce generalized anxiety, and may
also reduce anxiety sensitivity through exposure to feared physiological sensations. Accordingly, 54 participants with elevated anxiety sensitivity
scores completed six 20-min treadmill exercise sessions at either a high-intensity aerobic (n=29) or low-intensity (n=25) level. Self-ratings of
anxiety sensitivity, fear of physiological sensations associated with anxiety, and generalized anxiety were obtained at pre-treatment, post-
treatment, and one-week follow-up. Results indicated that both high- and low-intensity exercise reduced anxiety sensitivity. However, high-intensity
exercise caused more rapid reductions in a global measure of anxiety sensitivity and produced more treatment responders than low-intensity exercise.
Only high-intensity exercise reduced fear of anxiety-related bodily sensations. The implications of these findings are discussed.
Behaviour Research &
Therapy, 42(2) : 125-136
- Year: 2004
- Problem: Anxiety Disorders (any)
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Complementary & Alternative
Interventions (CAM), Physical activity, exercise
Birmaher, B., Axelson, D., Monk, K., Kalas, C., Clark, D., Ehmann, M., Bridge, J., Heo, J., Brent, D.
OBJECTIVE: To assess the efficacy and
tolerability of fluoxetine for the acute treatment of children and adolescents with generalized anxiety disorder, separation anxiety disorder, and/or
social phobia. METHOD: Anxious youths (7-17 years old) who had significant functional impairment were randomized to fluoxetine (20 mg/day) (n = 37)
or placebo (n = 37) for 12 weeks. RESULTS: Fluoxetine was effective in reducing the anxiety symptoms and improving functioning in all measures. Using
intent-to-treat analysis, 61% of patients taking fluoxetine and 35% taking placebo showed much to very much improvement. Despite this improvement, a
substantial group of patients remained symptomatic. Fluoxetine was well tolerated except for mild and transient headaches and gastrointestinal side
effects. Youths with social phobia and generalized anxiety disorder responded better to fluoxetine than placebo, but only social phobia moderated the
clinical and functional response. Severity of the anxiety at intake and positive family history for anxiety predicted poorer functioning at the end
of the study. CONCLUSIONS: Fluoxetine is useful and well tolerated for the acute treatment of anxious youths. Investigations regarding the
optimization of treatment to obtain full anxiety remission and the length of treatment necessary to prevent recurrences are warranted.
Journal of the American Academy of Child &
Adolescent Psychiatry, 42(4) : 415-423
- Year: 2003
- Problem: Anxiety Disorders (any)
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Selective serotonin reuptake inhibitors (SSRIs)
Kenardy, Justin, McCafferty, Kelly, Rosa, Virginia
The project aims to investigate the efficacy of a preventive cognitive
behavioural intervention delivered via the Internet to individuals at risk of developing anxiety disorders. There is increasing evidence that
suggests anxiety sensitivity may act as a premorbid risk factor for the development of anxiety pathology and panic disorder. Eighty-three university
students with elevated anxiety sensitivity were randomly allocated to either an intervention group (n=43), who worked through the Internet based
program over a period of 6 weeks, or a waitlist control group (n=40). Significant treatment effects were found for anxiety related cognitions and
symptoms of depression, and a non-significant trend for anxiety sensitivity. These outcomes were related to expectancy but not to program
utilization. Implications for the prevention of anxiety via the Internet are discussed. (PsycINFO Database Record (c) 2008 APA, all rights reserved)
(journal abstract).
Behavioural & Cognitive Psychotherapy, 31(3) : 279-
289
- Year: 2003
- Problem: Anxiety Disorders (any)
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions
(any), Other Psychological Interventions, Technology, interventions delivered using technology (e.g. online, SMS)
Lowry-Webster, Hayley M., Barrett, Paula M., Lock, Sally
In 2001 we evaluated a universal prevention trial of anxiety during childhood, and also examined
the effects of the program on levels of depression. Participants were 594 children aged 10-13 years from seven schools in Brisbane, Australia, who
were randomly assigned to an intervention or control group on a school-by-school basis. The intervention was based on the group CBT program FRIENDS
(Barrett, Lowry-Webster & Holmes, 1999a, 1999b, 1999c). Results were examined universally (for all children) and for children who scored above the
clinical cut-off for anxiety at pre-test. At 12-month follow-up, intervention gains were maintained, as measured by self-reports and diagnostic
interviews. Eighty-five per cent of children in the intervention group who were scoring above the clinical cut-off for anxiety and depression were
diagnosis free in the intervention condition, compared to only 31.2% of children in the control group. Implications of these findings are examined,
alongside limitations and directions for future research. (PsycINFO Database Record (c) 2008 APA, all rights reserved) (journal abstract).
Behaviour Change, 20(1) : 25-43
- Year: 2003
- Problem: Anxiety Disorders (any), Depressive Disorders
- Type: Randomised controlled trials
-
Stage: Universal prevention
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT)
Nauta,
Maaike H., Scholing, Agnes, Emmelkamp, Paul M., Minderaa, Ruud B.
Objective: To evaluate a 12-week cognitive-behavioral treatment
program for children with anxiety disorders and the additional value of a seven-session cognitive parent training program. Method: Seventy-nine
children with an anxiety disorder (aged 7-18 years) were randomly assigned to a cognitive behavioral treatment condition or a wait-list control
condition. Families in the active treatment condition were randomly assigned to an additional seven-session cognitive parent training program.
Semistructured diagnostic interviews were conducted with parents and children separately, before and after treatment and at 3 months follow-up.
Questionnaires included child self-reports on anxiety and depression and parent reports on child's anxiety and behavioral problems. Results:
Children with anxiety disorders showed more treatment gains from cognitive-behavioral therapy than from a wait-list control condition. These results
were substantial and significant in parent measures and with regard to diagnostic status, but not in child self-reports. In the active treatment
condition, children improved on self-reported anxiety and depression, as well as on parent reports on their child's anxiety problems. These results
were equal for clinically referred and recruited children... (PsycINFO Database Record (c) 2008 APA, all rights reserved) (journal abstract).
Journal of the American
Academy of Child & Adolescent Psychiatry, 42(11) : 1270-1278
- Year: 2003
- Problem: Anxiety Disorders (any)
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT)
Lytle, R. A., Hazlett-Stevens, H., Borkovec, T. D.
Much of the Eye Movement Desensitization and Reprocessing (EMDR) efficacy research has been widely criticized, limiting scientific
understanding of its therapeutic components. The present investigation of Eye Movement Desensitization (EMD) effectiveness included undergraduate
students reporting current intrusive cognitions conceming a traumatic event. Forty-five participants received a single treatment session of either:
(a) EMD, as described by Shapiro [J. Behav. Ther. Exp. Psychiatry 20 (1989b) 211], (b) an identical procedure which employed eye fixation on a
stationary target, or (c) non-directive counseling. Standardized self-report, subjective rating, Daily Diary, and intrusive thought sampling measures
were collected before and after treatment. Results indicated that participants in the eye fixation group reported marginally (p < .052) fewer
cognitive intrusions than the non-directive group 1 week following treatment. No significant differences between the EMD and non-directive conditions
or between the EMD and eye fixation conditions on this measure were found. During the treatment session, both desensitization groups were superior to
the non-directive group in reducing reported vividness of the mental image of the original event. However, the non-directive group improved to the
level of the two other groups by the following week. Rapid saccadic eye movements were therefore unrelated to immediate treatment effects for this
sub-clinical sample, and non-directive treatment largely yielded eventual outcomes equivalent to the two desensitization conditions.
Journal of Anxiety Disorders, 16(3) : 273-288
- Year: 2002
- Problem: Anxiety Disorders (any), Post Traumatic Stress Disorder
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions
(any), Eye movement desensitisation and reprocessing (EMDR), Other Psychological Interventions
Muris P, Meesters C, Gobel M.
The
present pilot-study was a first attempt to examine the effectiveness of the cognitive\rcomponent of cognitive behaviour therapy for children with
anxiety problems. A total of 24 highly anxious\rchildren were assigned to 1 of 2 intervention conditions: a Cognitive Coping intervention, which
focussed\rprimarily on the cognitive component of cognitive behaviour therapy, or an Emotional Disclosure\rintervention in which children were
invited to write about their fears and anxious experiences. Children\rcompleted self-report questionnaires of anxiety disorders symptoms and worry at
3 points in time: (i) 6\rweeks before treatment (i.e. baseline), (ii) at pre-treatment, and (iii) at post-treatment. The results showed,\rfirstly,
that levels of anxiety disorder symptoms and worry remained relatively stable over a 6-week waiting\rperiod and then decreased substantially after
the interventions. This suggests that the children did not suffer\rfrom momentary anxiety and worry complaints and that treatments generally were
effective in reducing\rthese symptoms. Secondly, although within-group comparisons suggested that treatment effects were\rsomewhat larger in the
Cognitive Coping condition than in the Emotional Disclosure condition (effects sizes\rfor anxiety disorders symptoms and worry were, respectively,
1.03 and 0.87 for Cognitive Coping vs 0.54\rand 0.39 for Emotional Disclosure), statistical tests could not substantiate this impression, probably
due to a\rlack of power as a result of the small numbers of children in both intervention conditions
Cognitive Behaviour
Therapy, 31(2) : 59-67
- Year: 2002
- Problem: Anxiety Disorders (any)
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT), Other Psychological Interventions