Cognitive-behavioral therapy for anxiety disordered youth: A randomized clinical trial evaluating child and family modalities.

TLDR

A randomized clinical trial enrolled 161 youth (ages 7‑14) with separation anxiety, social phobia, or generalized anxiety disorder and compared individual CBT, family CBT, and a family education/support control using hierarchical linear models and chi‑square analyses on diagnostic severity, self‑, parent‑, and teacher‑reported outcomes at post‑treatment and 1‑year follow‑up. All groups showed treatment gains, but family CBT and individual CBT were superior to the control in reducing the principal anxiety disorder, with individual CBT outperforming family CBT and the control on teacher reports; gains were maintained at 1‑year, and family CBT was superior when both parents had an anxiety disorder.

Abstract

This randomized clinical trial compared the relative efficacy of individual (child) cognitive-behavioral therapy (ICBT), family cognitive-behavioral therapy (FCBT), and a family-based education/support/ attention (FESA) active control for treating anxiety disordered youth ages 7-14 years (M = 10.27). Youth (N = 161; 44% female; 85% Caucasian, 9% African American, 3% Hispanic, 3% other/mixed) with a principal diagnosis of separation anxiety disorder, social phobia, or generalized anxiety disorder and their parents participated. Outcome analyses were conducted using hierarchical linear models on the intent-to-treat sample at posttreatment and 1-year follow-up using diagnostic severity, child self-reports, parent reports, and teacher reports. Chi-square analyses were also conducted on diagnostic status at post and 1-year follow-up. Children evidenced treatment gains in all conditions, although FCBT and ICBT were superior to FESA in reducing the presence and principality of the principal anxiety disorder, and ICBT outperformed FCBT and FESA on teacher reports of child anxiety. Treatment gains, when found, were maintained at 1-year follow-up. FCBT outperformed ICBT when both parents had an anxiety disorder. Implications for treatment and suggestions for research are discussed.