CBT Can Yield Lasting Improvements in Anxiety

HONOLULU – Anxious children who participated in a 9-week course of cognitive-behavioral therapy maintained improvements for at least 4 years, especially if their parents also received training, according to a randomized, placebo-controlled trial.

This is the longest follow-up study of cognitive-behavioral therapy (CBT) for anxious children in which comparison with a control group was possible, wrote Dr. Gail A. Bernstein of the University of Minnesota, Minneapolis. Dr. Bernstein was the lead author of the study, which was presented during a poster session at the annual meeting of the American Academy of Child and Adolescent Psychiatry.

The study involved 61 children, aged 7–11 years, all of whom had features of separation anxiety disorder, generalized anxiety disorder, and/or social phobia. Investigators randomized the children by school into one of three treatment conditions. In one group, the children received a 9-week manual- and workbook-based CBT intervention using the FRIENDS for Life, a school-based anxiety prevention program. In the second arm, the children received the CBT intervention and, in addition, their parents participated in a 9-week concurrent training group based on the FRIENDS program. Children in the third arm received no treatment.

Six months after the treatment phase of the study, the 24 control families were offered treatment. Five of these families were randomly assigned to the CBT group, 7 were randomly assigned to CBT plus parent training, and 12 families declined treatment. Of those 12 families, 8 continued to participate in the assessments at years 2, 3, and 4.

All groups–including the controls–showed improvement in anxiety symptoms. However, at the 4-year follow-up, 43% of children in the control group showed remission of their primary anxiety diagnoses, a significantly smaller proportion than the children in the CBT group (75%) or the children in the CBT plus parent training group (76%).

Also at 4 years, only 29% of the children in the CBT plus parent training group qualified for an anxiety diagnosis. This is significantly lower than those in the CBT group (67%) or the control group (57%).

The child-plus-parent group also had significantly better scores at 4 years on the clinician severity rating (CSR) of the Anxiety Disorders Interview Schedule. At baseline the mean composite CSR scores for the three groups ranged between 2.4 and 3.9 on a scale from 0 to 8. At the 4-year follow-up the mean composite CSR score for the child–plus-parent training group had declined to 0.76. This was a significantly lower than the CBT alone group (2.25) and the control group (1.86).

Other studies have conducted long-term follow-up of CBT in anxious children, but the investigators wrote that this was the first in which comparison with a control group was possible in the 4 years after treatment. Of six other follow-up studies, only one maintained the control group, and that was for only 2 years. The other studies provided CBT to the control participants during or shortly after the intervention phase.

Dr. Bernstein reported no conflicts of interest related to her presentation. Her research was funded by the National Institute of Mental Health, the University of Minnesota Academic Health Center, and the Minnesota Medical Foundation.

HONOLULU – Anxious children who participated in a 9-week course of cognitive-behavioral therapy maintained improvements for at least 4 years, especially if their parents also received training, according to a randomized, placebo-controlled trial.

This is the longest follow-up study of cognitive-behavioral therapy (CBT) for anxious children in which comparison with a control group was possible, wrote Dr. Gail A. Bernstein of the University of Minnesota, Minneapolis. Dr. Bernstein was the lead author of the study, which was presented during a poster session at the annual meeting of the American Academy of Child and Adolescent Psychiatry.

The study involved 61 children, aged 7–11 years, all of whom had features of separation anxiety disorder, generalized anxiety disorder, and/or social phobia. Investigators randomized the children by school into one of three treatment conditions. In one group, the children received a 9-week manual- and workbook-based CBT intervention using the FRIENDS for Life, a school-based anxiety prevention program. In the second arm, the children received the CBT intervention and, in addition, their parents participated in a 9-week concurrent training group based on the FRIENDS program. Children in the third arm received no treatment.

Six months after the treatment phase of the study, the 24 control families were offered treatment. Five of these families were randomly assigned to the CBT group, 7 were randomly assigned to CBT plus parent training, and 12 families declined treatment. Of those 12 families, 8 continued to participate in the assessments at years 2, 3, and 4.

All groups–including the controls–showed improvement in anxiety symptoms. However, at the 4-year follow-up, 43% of children in the control group showed remission of their primary anxiety diagnoses, a significantly smaller proportion than the children in the CBT group (75%) or the children in the CBT plus parent training group (76%).

Also at 4 years, only 29% of the children in the CBT plus parent training group qualified for an anxiety diagnosis. This is significantly lower than those in the CBT group (67%) or the control group (57%).

The child-plus-parent group also had significantly better scores at 4 years on the clinician severity rating (CSR) of the Anxiety Disorders Interview Schedule. At baseline the mean composite CSR scores for the three groups ranged between 2.4 and 3.9 on a scale from 0 to 8. At the 4-year follow-up the mean composite CSR score for the child–plus-parent training group had declined to 0.76. This was a significantly lower than the CBT alone group (2.25) and the control group (1.86).

Other studies have conducted long-term follow-up of CBT in anxious children, but the investigators wrote that this was the first in which comparison with a control group was possible in the 4 years after treatment. Of six other follow-up studies, only one maintained the control group, and that was for only 2 years. The other studies provided CBT to the control participants during or shortly after the intervention phase.

Dr. Bernstein reported no conflicts of interest related to her presentation. Her research was funded by the National Institute of Mental Health, the University of Minnesota Academic Health Center, and the Minnesota Medical Foundation.

HONOLULU – Anxious children who participated in a 9-week course of cognitive-behavioral therapy maintained improvements for at least 4 years, especially if their parents also received training, according to a randomized, placebo-controlled trial.

This is the longest follow-up study of cognitive-behavioral therapy (CBT) for anxious children in which comparison with a control group was possible, wrote Dr. Gail A. Bernstein of the University of Minnesota, Minneapolis. Dr. Bernstein was the lead author of the study, which was presented during a poster session at the annual meeting of the American Academy of Child and Adolescent Psychiatry.

The study involved 61 children, aged 7–11 years, all of whom had features of separation anxiety disorder, generalized anxiety disorder, and/or social phobia. Investigators randomized the children by school into one of three treatment conditions. In one group, the children received a 9-week manual- and workbook-based CBT intervention using the FRIENDS for Life, a school-based anxiety prevention program. In the second arm, the children received the CBT intervention and, in addition, their parents participated in a 9-week concurrent training group based on the FRIENDS program. Children in the third arm received no treatment.

Six months after the treatment phase of the study, the 24 control families were offered treatment. Five of these families were randomly assigned to the CBT group, 7 were randomly assigned to CBT plus parent training, and 12 families declined treatment. Of those 12 families, 8 continued to participate in the assessments at years 2, 3, and 4.

All groups–including the controls–showed improvement in anxiety symptoms. However, at the 4-year follow-up, 43% of children in the control group showed remission of their primary anxiety diagnoses, a significantly smaller proportion than the children in the CBT group (75%) or the children in the CBT plus parent training group (76%).

Also at 4 years, only 29% of the children in the CBT plus parent training group qualified for an anxiety diagnosis. This is significantly lower than those in the CBT group (67%) or the control group (57%).

The child-plus-parent group also had significantly better scores at 4 years on the clinician severity rating (CSR) of the Anxiety Disorders Interview Schedule. At baseline the mean composite CSR scores for the three groups ranged between 2.4 and 3.9 on a scale from 0 to 8. At the 4-year follow-up the mean composite CSR score for the child–plus-parent training group had declined to 0.76. This was a significantly lower than the CBT alone group (2.25) and the control group (1.86).

Other studies have conducted long-term follow-up of CBT in anxious children, but the investigators wrote that this was the first in which comparison with a control group was possible in the 4 years after treatment. Of six other follow-up studies, only one maintained the control group, and that was for only 2 years. The other studies provided CBT to the control participants during or shortly after the intervention phase.

Dr. Bernstein reported no conflicts of interest related to her presentation. Her research was funded by the National Institute of Mental Health, the University of Minnesota Academic Health Center, and the Minnesota Medical Foundation.