Group CBT May Be Best Choice for Anxiety Disorders in Kids

November 8, 2018

By Will Boggs MD

NEW YORK—Group cognitive-behavioral therapy (CBT) appears to be the best choice of psychotherapy for anxiety disorders in children and adolescents, according to a network meta-analysis of 11 different therapies.

As many as 20% of children and adolescents will experience anxiety disorders, researchers say, and psychological treatments such as CBT are commonly used.

There are limited data on the relative effectiveness of CBT and other behavioral therapies, and on whether outcomes differ between psychotherapy delivered individually or in a group setting, note Dr. Peng Xie of The First Affiliated Hospital of Chongqing Medical University, in Chongqing, China, and colleagues in JAMA Psychiatry, online October 31.

The team undertook a network meta-analysis to compare and rank psychological interventions for the acute treatment of anxiety disorders in children and adolescents.

Only 7.9% of the 101 included trials were rated as having low risk of bias; 71.3% were rated as having a moderate risk of bias and 20.8% were rated as having a high risk of bias.

In terms of efficacy, group CBT, individual CBT and parental-involvement CBT outperformed the waitlist comparative group posttreatment and at follow-up.

For acceptability, bibliotherapy CBT proved less acceptable than group CBT with parental involvement and the waitlist condition. For quality of life/functioning, group CBT with parental involvement, individual CBT, individual and group behavioral therapy, Internet-assisted CBT and parent-only CBT outperformed the waitlist condition or psychological placebo.

In the network meta-analysis, group CBT was the only psychotherapy that was significantly more effective than all neutral conditions and most other psychotherapies.

Group CBT was more efficacious than group CBT with parental involvement and all control conditions at short-term follow-up.

Psychological placebo outperformed the waitlist condition in terms of efficacy posttreatment and at follow-up.

Almost all CBT (but not behavioral therapy) provided better quality of life/functioning outcomes compared with psychological placebo or the waitlist condition.

"Overall, the clinical interpretation of these findings is limited, not only by the small number of trials in each node, but also by the poor methodology, risk of bias of individual studies, large inconsistency of the network, and potential selective reporting," the researchers caution.

"This network meta-analysis suggests that group CBT might be considered as the initial choice of psychotherapy for anxiety disorders in children and adolescents," they conclude. "However, more research is needed to confirm such conclusions."

Dr. Jeffrey R. Strawn, director of the Anxiety Disorders Research Program at the University of Cincinnati and Cincinnati Children's Hospital Medical Center, told Reuters Health by email, "Accumulating data in the pediatric anxiety disorders suggest that exposure is a critical component to treatment success. Thus, some of the benefits of the group therapy, particularly depending on the number of patients with social anxiety disorder enrolled, may be attributed to the increased social exposure that occurred in the group format."

"While this meta-analysis provides comparative estimates of the relative effects of different types of psychotherapy for pediatric anxiety disorders, clinicians must consider clinical factors, including the severity of anxiety and comorbidity, in selecting evidence-based treatment for pediatric anxiety disorders," he said. "In this regard, a recent analysis of the Child/Adolescent Multimodal Anxiety Study of Anxiety (CAMS) suggests that for pediatric patients with severe anxiety, improvement may require both psychotherapy and pharmacotherapy."

He added, "While the findings of this network meta-analysis raise the possibility that some formats should be considered preferentially over others, prospective trials directly comparing delivery formats are urgently needed."

Dr. Xie and coauthor Dr. Andrea Cipriani of the University of Oxford did not respond to a request for comments.


JAMA Psychiatry 2018.

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