Katharina Manassis1, Trevor Changgun Lee2, Kathryn Bennett3, Xiu Yan Zhao4, Sandra Mendlowitz5, Stephanie Duda6, Michael Saini7, Pamela Wilansky8, Susan Baer9, Paula Barrett10, Denise Bodden11, Vanessa E Cobham12, Mark R Dadds13, Ellen Flannery-Schroeder14, Golda Ginsburg15, David Heyne16, Jennifer L Hudson17, Philip C Kendall18, Juliette Liber16, Carrie Masia-Warner19, Maaike H Nauta20, Ronald M Rapee17, Wendy Silverman21, Lynne Siqueland22, Susan H Spence23, Elisabeth Utens24, Jeffrey J Wood25. 1. Department of Psychiatry. 2. Faculty of Medicine, University of Toronto. 3. McMaster University. 4. Biostatistics, Design, and Analysis Unit, Hospital for Sick Children. 5. Department of Psychiatry, Hospital for Sick Children. 6. Clinical Epidemiology and Biostatistics, McMaster University. 7. Faculty of Social Work, University of Toronto. 8. Department of Psychiatry, University of Toronto. 9. Department of Psychiatry, University of British Columbia. 10. Pathways Health and Research Centre, West End. 11. University of Utrecht. 12. School of Psychology, University of Queensland. 13. School of Psychology, University of New South Wales. 14. University of Rhode Island. 15. Johns Hopkins University School of Medicine. 16. Leiden University. 17. Department of Psychology, Macquarie University. 18. Department of Psychology, Temple University. 19. Department of Psychology, William Paterson University. 20. University of Groningen. 21. Department of Psychiatry, Yale University. 22. Children's Center for OCD and Anxiety. 23. Griffith University. 24. Erasmus Medical Center Sophia-Children's Hospital. 25. Department of Psychiatry, University of California.
Abstract
OBJECTIVE: Meta-analytic studies have not confirmed that involving parents in cognitive behavior therapy (CBT) for anxious children is therapeutically beneficial. There is also great heterogeneity in the type of parental involvement included. We investigated parental involvement focused on contingency management (CM) and transfer of control (TC) as a potential outcome moderator using a meta-analysis with individual patient data. METHOD: Investigators of randomized controlled trials (RCTs) of CBT for anxious children, identified systematically, were invited to submit their data. Conditions in each RCT were coded based on type of parental involvement in CBT (i.e., low involvement, active involvement without emphasis on CM or TC, active involvement with emphasis on CM or TC). Treatment outcomes were compared using a 1-stage meta-analysis. RESULTS: All cases involved in active treatment (894 of 1,618) were included for subgroup analyses. Across all CBT groups, means of clinical severity, anxiety, and internalizing symptoms significantly decreased posttreatment and were comparable across groups. The group without emphasis on CM or TC showed a higher proportion with posttreatment anxiety diagnoses than the low-involvement group. Between posttreatment and 1-year follow-up, the proportion with anxiety diagnoses significantly decreased in CBT with active parental involvement with emphasis on CM or TC, whereas treatment gains were merely maintained in the other 2 groups. CONCLUSIONS: CBT for anxious children is an effective treatment with or without active parental involvement. However, CBT with active parental involvement emphasizing CM or TC may support long-term maintenance of treatment gains. RESULTS should be replicated as additional RCTs are published.
OBJECTIVE: Meta-analytic studies have not confirmed that involving parents in cognitive behavior therapy (CBT) for anxiouschildren is therapeutically beneficial. There is also great heterogeneity in the type of parental involvement included. We investigated parental involvement focused on contingency management (CM) and transfer of control (TC) as a potential outcome moderator using a meta-analysis with individual patient data. METHOD: Investigators of randomized controlled trials (RCTs) of CBT for anxiouschildren, identified systematically, were invited to submit their data. Conditions in each RCT were coded based on type of parental involvement in CBT (i.e., low involvement, active involvement without emphasis on CM or TC, active involvement with emphasis on CM or TC). Treatment outcomes were compared using a 1-stage meta-analysis. RESULTS: All cases involved in active treatment (894 of 1,618) were included for subgroup analyses. Across all CBT groups, means of clinical severity, anxiety, and internalizing symptoms significantly decreased posttreatment and were comparable across groups. The group without emphasis on CM or TC showed a higher proportion with posttreatment anxiety diagnoses than the low-involvement group. Between posttreatment and 1-year follow-up, the proportion with anxiety diagnoses significantly decreased in CBT with active parental involvement with emphasis on CM or TC, whereas treatment gains were merely maintained in the other 2 groups. CONCLUSIONS: CBT for anxiouschildren is an effective treatment with or without active parental involvement. However, CBT with active parental involvement emphasizing CM or TC may support long-term maintenance of treatment gains. RESULTS should be replicated as additional RCTs are published.
Authors: Guillermo Perez Algorta; Heather A MacPherson; Eric A Youngstrom; Caroline C Belt; L Eugene Arnold; Thomas W Frazier; H Gerry Taylor; Boris Birmaher; Sarah McCue Horwitz; Robert L Findling; Mary A Fristad Journal: J Clin Child Adolesc Psychol Date: 2017-02-26
Authors: Courtney Benjamin Wolk; Nicole E Caporino; Susanna McQuarrie; Cara A Settipani; Jennifer L Podell; Sarah Crawley; Rinad S Beidas; Philip C Kendall Journal: J Anxiety Disord Date: 2016-03-05