Computer-Assisted Cognitive Behavioral Therapy for Child Anxiety: Results of a Randomized Clinical Trial

University of Pennsylvania, Department of Psychiatry, 3535 Market Street, Suite 600, Philadelphia, PA 19104, USA.
Journal of Consulting and Clinical Psychology (Impact Factor: 4.85). 10/2010; 78(5):737-45. DOI: 10.1037/a0019739
Source: PubMed

ABSTRACT This study examined the feasibility, acceptability, and effects of Camp Cope-A-Lot (CCAL), a computer-assisted cognitive behavioral therapy (CBT) for anxiety in youth.
Children (49; 33 males) ages 7-13 (M = 10.1 ± 1.6; 83.7% Caucasian, 14.2% African American, 2% Hispanic) with a principal anxiety disorder were randomly assigned to (a) CCAL, (b) individual CBT (ICBT), or (c) a computer-assisted education, support, and attention (CESA) condition. All therapists were from the community (school or counseling psychologists, clinical psychologist) or were PsyD or PhD trainees with no experience or training in CBT for child anxiety. Independent diagnostic interviews and self-report measures were completed at pre- and posttreatment and 3-month follow-up.
At posttreatment, ICBT or CCAL children showed significantly better gains than CESA children; 70%, 81%, and 19%, respectively, no longer met criteria for their principal anxiety diagnosis. Gains were maintained at follow-up, with no significant differences between ICBT and CCAL. Parents and children rated all treatments acceptable, with CCAL and ICBT children rating higher satisfaction than CESA children.
Findings support the feasibility, acceptability and beneficial effects of CCAL for anxious youth. Discussion considers the potential of computer-assisted treatments in the dissemination of empirically supported treatments.

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Available from: Muniya Khanna, Jul 07, 2015
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    • ", 2011 ) . Of the two studies of cCBT in children , one was considered to have high therapist input ( Khanna & Kendall , 2010 ) and the other was considered to have some therapist input ( March et al . , 2009 ) . "
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    ABSTRACT: One quarter of children and young people (CYP) experience anxiety and/or depression before adulthood, but treatment is sometimes unavailable or inadequate. Self-help interventions may have a role in augmenting treatment and this work aimed to systematically review the evidence for computerised anxiety and depression interventions in CYP aged 5-25 years old. Databases were searched for randomised controlled trials and 27 studies were identified. For young people (12-25 years) with risk of diagnosed anxiety disorders or depression, computerised CBT (cCBT) had positive effects for symptoms of anxiety (SMD -0.77, 95% CI -1.45 to -0.09, k = 6, N = 220) and depression (SMD -0.62, 95% CI -1.13 to -0.11, k = 7, N = 279). In a general population study of young people, there were small positive effects for anxiety (SMD -0.15, 95% CI -0.26 to -0.03; N = 1273) and depression (SMD -0.15, 95% CI -0.26 to -0.03; N = 1280). There was uncertainty around the effectiveness of cCBT in children (5-11 years). Evidence for other computerised interventions was sparse and inconclusive. Computerised CBT has potential for treating and preventing anxiety and depression in clinical and general populations of young people. Further program development and research is required to extend its use and establish its benefit in children. Copyright © 2015 Elsevier Ltd. All rights reserved.
    Behaviour Research and Therapy 02/2015; 67C. DOI:10.1016/j.brat.2015.01.009 · 3.85 Impact Factor
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    • "With respect to child anxiety disorders specifically, there has been surprisingly few investigations in this area. Using a CD-Rom approach, Khanna and Kendall (2010) investigated the efficacy of their 'Camp-Cope-a-Lot' program for 7-13 year-old children. These authors found the program to be equally efficacious as face-to-face therapy, with participants reporting high levels of satisfaction with it. "
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    ABSTRACT: The aim of this study was to investigate the efficacy of an internet-based, therapist assisted, parent-focussed, CBT program for preschoolers with anxiety disorders. Fifty-two children aged 3-6 years were randomly allocated into internet treatment (NET) and waitlist control (WLC) groups. Parents completed diagnostic interviews and online questionnaires at pre-treatment, post-treatment and 6-month follow-up. Results at post-treatment showed a significantly greater reduction in clinical severity, anxiety symptoms and internalising behaviour, as well as a greater increase in overall functioning for children in the NET compared to the WLC condition. However, group differences were not evident from pre- to post-treatment on the percentages of children who lost their primary anxiety diagnosis or who lost all anxiety diagnoses. At post-treatment for the completer sample, 39.1% of the NET children compared to 25.9% of the WLC were free of their primary diagnosis. At 6-month follow-up, treatment gains were maintained in the case of overall functioning and further improved upon with respect to clinical severity, anxiety symptoms and internalising behaviour. By 6-month follow-up for the completer sample, 70.6% of children were free of their primary diagnosis. The results suggest that an internet program for preschool anxiety is feasible, efficacious and well received by parents.
    Behaviour Research and Therapy 05/2014; 58C:24-35. DOI:10.1016/j.brat.2014.05.001 · 3.85 Impact Factor
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    • "A few studies have evaluated ICBT or computerized CBT for children with anxiety disorders, including SP, with a transdiagnostic manual where exposure is a component of treatment but not performed in front of the computer (Richardson, Stallard, & Velleman, 2010). Significant and large effect sizes were found for these treatments where SP was included (Khanna & Kendall, 2010; March, Spence, & Donovan, 2009; Spence et al., 2011; Wuthrich et al., 2012). To the best of our knowledge, there are no studies on ICBT for SP in youth where exposure is conducted in vivo. "
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    ABSTRACT: Background: Cognitive behavior therapy (CBT) has been shown to be an effective treatment for specific phobia in youth, but not all affected seek or receive treatment. Internet-delivered CBT could be a way to increase the availability of empirically supported treatments. Aims: An open trial was conducted to evaluate Internet-delivered CBT for children with specific phobia. Method: Children (N = 30) aged 8-12, and their parents, with a principal diagnosis of specific phobia were recruited through media advertisement. Participants received six weeks of Internet-delivered CBT with therapist support. The treatment was aimed for the parents and the children, with the first part being only for the parents. The primary outcome measure was the Clinician Severity Rating (CSR), and secondary measures included clinician-rated global functioning and child- and parent-reported anxiety and quality of life. All assessments were made at pretreatment, posttreatment, and three-month follow-up. Results: At posttreatment, there were significant reductions on the CSR, with a large within-group effect size (Cohen's d = 1.0) and 35% of children no longer meeting criteria for specific phobia. Self-report measures from parents and children showed significant effects on anxiety, with small to moderate effect sizes. Effects were maintained at three-month follow-up. Conclusions: Results show that Internet-delivered CBT with therapist support for children with specific phobia has the potential to reduce symptom severity. Randomized controlled trials are needed to further evaluate this treatment format.
    Cognitive behaviour therapy 12/2013; 42(4):303-314. DOI:10.1080/16506073.2013.844201