Group CBT may be best for treatment of anxiety disorders in children

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Group cognitive behavioural therapy (CBT) could be the best choice of psychotherapy for anxiety disorders in children and adolescents, according to a network meta-analysis study from Oxford University.

CBT is a talking therapy designed to help people manage problems by encouraging positive changes in the way they think and behave. It is widely used to treat anxiety and depression, as well as other mental and physical health problems, especially in adults, as it is designed to help people to deal with overwhelming problems in a more positive way by breaking them down into smaller parts.

The new study showed that only group CBT was significantly more effective in reducing anxiety symptoms than other psychotherapies and all control conditions immediately after treatment and at short term follow up.

It is believed that psychotherapy delivered in a group format may generally result in better outcomes for patients due to the additional exposure of social stimuli and interaction within the group format.

The study’s author, Professor Andrea Cipriani of Oxford University’s department of psychiatry, said: ‘This study is encouraging because it shows that there is real benefit in long-established psychological treatments for anxiety disorders in adolescents.

“Ongoing debate regarding the different components and format of psychotherapy leads to uncertainty in the decision making for health care professionals and patients, and this may help to create clearer guidance for healthcare professionals. We need to assess long term effect of psychotherapies and more research is needed to replicate these findings and explore specific treatment effect and outcomes for different patient populations.”

The study included 101 unique randomised clinical trials (about 7,000 participants) that compared any structured psychotherapy with another psychotherapy or a control condition for anxiety disorders in children and adolescents. It found also that CBT, delivered in different ways, was significantly beneficial compared with placebo or waiting list in terms of improving children’s and adolescent’s quality of life and functional improvement.

Abstract

Importance: Anxiety disorders are common in children and adolescents, and uncertainty remains regarding the optimal strategy of psychotherapies in this population.
Objective: To compare and rank the different types of psychotherapies and the different ways of delivering psychological treatments for anxiety disorders in children and adolescents.
Data Sources: PubMed, Cochrane Central Register of Controlled Trials, EMBASE, PsycINFO, Web of Science, CINAHL (Cumulative Index to Nursing and Allied Health Literature), ProQuest Dissertations, LILACS (Literatura Latino Americana em Ciências da Saúde), international trial registers, and US Food and Drug Administration reports were searched from inception to November 30, 2017.
Study Selection: Randomized clinical trials that compared any structured psychotherapy with another psychotherapy or a control condition for anxiety disorders in children and adolescents were selected.
Data Extraction and Synthesis: Four researchers independently performed data extraction and quality assessment. Pairwise meta-analyses and Bayesian network meta-analysis within the random-effects model were used to synthesize data.
Main Outcomes and Measures: Efficacy (change in anxiety symptoms) posttreatment and at follow-up, acceptability (all-cause discontinuation), and quality of life and functional improvement were measured. The certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation framework.
Results: A total of 101 unique trials including 6625 unique participants compared 11 different psychotherapies with 4 specific control conditions. The certainty of evidence was rated as low or very low for most comparisons. For efficacy, most psychotherapies were significantly more effective than the wait list condition posttreatment (standardized mean difference [SMD], −1.43 to −0.61) and at the longest follow-up (SMD, −1.84 to −1.64). However, only group cognitive behavioral therapy (CBT) was significantly more effective than the other psychotherapies and all control conditions posttreatment. For acceptability, bibliotherapy CBT had significantly more all-cause discontinuations than some psychotherapies and control conditions (range of odds ratios, 2.48-9.32). In terms of quality of life and functional improvement, CBT (delivered in different ways) was significantly beneficial compared with psychological placebo and the wait list condition (SMDs, 0.73 to 1.99).
Conclusions and Relevance: Group CBT would be the more appropriate choice of psychotherapy for anxiety disorders in children and adolescents, based on these findings. Other types of psychotherapies and different ways of delivering psychological treatment can be alternative options. Further research is needed to explore specific anxiety disorders, disorder-specific psychotherapy, and moderators of treatment effect.

Authors
Xinyu Zhou; Yuqing Zhang; Toshiaki A Furukawa; Pim Cuijpers; Juncai Pu; John R Weisz; Lining Yang; Sarah E Hetrick; Cinzia Del Giovane; David Cohen; Anthony C James; Shuai Yuan; Craig Whittington; Xiaofeng Jiang; Teng Teng; Andrea Cipriani; Peng Xie

Oxford University material
JAMA Psychiatry abstract


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