DynaMed EBM Focus 5: Parent-Delivered Cognitive-Behavioral Therapy May Improve Anxiety in Children

Last week 523 journal articles were evaluated via DynaMed's Systematic Literature Surveillance and summaries of 159 articles were added to DynaMed content.

Based on criteria for selecting "articles most likely to change clinical practice," one article was selected by the DynaMed Editorial Team.

Parent-Delivered Cognitive-Behavioral Therapy May Improve Anxiety in Children
Reference: Br J Psychiatry 2013 Dec;203(6):436 (level 2 [mid-level] evidence)

Anxiety disorders are common in children and can have both immediate and life-long consequences. Cognitive behavioral therapy (CBT) has been shown to be effective for childhood and adolescent anxiety disorders (Cochrane Database Syst Rev 2013 Jun 3;(6):CD004690), but access to treatment may be limited. A recent randomized trial evaluated a low-intensity CBT intervention delivered by parents (with guidance from therapists) for children with anxiety disorders in the United Kingdom.

A total of 194 children aged 7-12 years with diagnosed anxiety disorders (generalized anxiety disorder, social phobia, separation anxiety disorder, panic disorder/agoraphobia, and specific phobias) were randomized to 1 of 2 parent-delivered CBT interventions vs. waitlist control for 12 weeks. In the full-guidance CBT group, parents received a self-help book and had 4 face-to-face meetings and 4 telephone calls with therapists (one contact weekly for the first 8 weeks, total therapist time < 5.5 hours) to provide anxiety education, develop graded exposure plan, and review progress. Parents in the brief-guidance CBT group received similar training and feedback from therapists but with a total of 4 sessions every other week. Families in the waitlist control group were asked to hold off on any anxiety interventions for 12 weeks.

At the end of treatment, rates of recovery from the primary anxiety diagnosis were 50% in the full-guidance CBT group and 25% in the waitlist control group (p = 0.013, NNT 4). In the full-guidance group, 34% of children recovered from all anxiety diagnoses compared to 11% of controls (p = 0.006, NNT 5). Recovery rates were higher in the brief-guidance group than in controls, but the differences were not statistically significant. Both full and brief guidance were associated with higher rates of "much or very much improved" status on clinical global impression ratings compared to control. In a follow-up analysis of 49 children from the full-guidance group at 6 months, 76% no longer met the diagnostic criteria for their primary diagnosis. While the lack of a true attention control condition weakens this trial’s validity, it appears that parent-led CBT may be an effective low-cost first-line approach for treating childhood anxiety disorders before seeking more intensive treatment.

For more information see the Generalized anxiety disorder, Panic disorder, and School refusal topics in Dynamed

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