Working to optimize treatment outcome and use resources efficiently, investigators conducted the first test of an existing parent-only group cognitive-behavioral therapy protocol to treat 24 children 7 to 16 years old with primary anxiety disorder diagnoses.
Over the course of 7 months, the authors evaluated a manual-based therapy protocol that teaches parents skills to work with their children as lay therapists in the context of their ongoing interactions and daily life. This was an uncontrolled pilot study, examining within-subject outcomes via measures from multiple informants, aimed at generating estimates of effect size.
Children demonstrated significant improvement on parent- and clinician-rated measures of anxiety. Twenty-five percent of primary anxiety diagnoses fully remitted, and the average number of anxiety diagnoses dropped from 3.4 to 1.5. The intervention had a large effect on anxiety disorder severity and impairment, parental attitudes, targeted anxious behavior problems, and clinician-rated impairment. Children with anxiety-disordered parents reported more improvement than children whose parents were not anxious. The intervention was acceptable to families.
The results of this pilot study suggest that parents acting as lay cognitive-behavioral therapists for their anxious children may be effectively and acceptably trained in a group format.
"These sample sizes are similar to or exceed those reported in other treatment studies for childhood anxiety disorders (e.g., Bogels & Siqueland, 2006; Cartwright-Hatton et al., 2005; Mendlowitz et al., 1999; Spence et al., 2006; Thienemann et al., 2006). "
[Show abstract][Hide abstract] ABSTRACT: The present study compared the efficacy of a group-based cognitive-behavioural treatment (GCBT) delivered exclusively to parents of young anxious children (between 4 and 8 years of age) with the same intervention delivered to both children and parents, relative to a Wait-list Control condition. Parents of children in the Parent Only condition (N = 25) received 10 weekly sessions of GCBT whereas children and parents in the Parent + Child condition (N = 24) each received 10 weekly sessions of GCBT. Intent-to-treat analyses indicated that both active treatment conditions were superior to the Wait-list condition (N = 11), with 55.3% of children in the Parent Only condition and 54.8% of children in the Parent + Child condition no longer meeting criteria for their principal diagnosis at post-treatment. These treatment gains were maintained in both treatment conditions at six-month and 12-month follow-up assessments. There were no significant differences between the two active conditions on other outcome measures including parental psychopathology and parenting style. However, an unexpected finding was that parenting satisfaction and to some extent parenting competence reduced significantly from pre- to post-treatment regardless of the active treatment condition. The present results suggest that GCBT delivered exclusively to parents of young anxious children may be a viable treatment alternative for improving accessibility to efficacious treatments for children with anxiety disorders and for reducing costs associated with mental health care delivery.
Behaviour Research and Therapy 06/2009; 47(8):654-62. DOI:10.1016/j.brat.2009.04.008 · 3.85 Impact Factor
"Other recent studies did not find any association between parental internalizing psychopathology and treatment outcome (Victor et al., 2006; Wood et al., 2006). Finally, two studies even demonstrated that anxious children with anxious mothers had more favorable treatment outcomes compared to children with nonanxious mothers (Thienemann et al., 2006; Toren et al., 2000). These diverse findings between previous studies may be accounted for by different study methods, such as sample size, sample characteristics, treatment protocol, child anxiety assessment (e.g. "
[Show abstract][Hide abstract] ABSTRACT: The aim of the present thesis was to explore wether parental psychopathology and threat-related selective attention were related to outcome of cognitive-behavioral therapy in anxiety-disordered children and adolescents. Pre- to post-treatment changes of selective attention were also examined in relation to treatment success. The second aim was to examine whether cognitive coping after the experience of negative life events is related to anxiety disorders in children and adolescents.
[Show abstract][Hide abstract] ABSTRACT: The article reviews psychosocial treatments for phobic and anxiety disorders in youth. Using criteria from Nathan and Gorman (2002), 32 studies are evaluated along a continuum of methodological rigor. In addition, the treatments evaluated in each of the 32 studies are classified according to Chambless et al.'s (1996) and Chambless and Hollon's (1998) criteria. Findings from a series of meta-analyses of the studies that used waitlists also are reported. In accordance with Nathan and Gorman, the majority of the studies were either methodologically robust or fairly rigorous. In accordance with Chambless and colleagues, although no treatment was well-established, Individual Cognitive Behavior Therapy, Group Cognitive Behavior Therapy (GCBT), GCBT with Parents, GCBT for social phobia (SOP), and Social Effectiveness Training for children with SOP each met criteria for probably efficacious. The other treatments were either possibly efficacious or experimental. Meta-analytic results revealed no significant differences between individual and group treatments on diagnostic recovery rates and anxiety symptom reductions, as well as other youth symptoms (i.e., fear, depression, internalizing and externalizing problems). Parental involvement was similarly efficacious as parental noninvolvement in individual and group treatment formats. The article also provides a summary of the studies that have investigated mediators, moderators, and predictors of treatment outcome. The article concludes with a discussion of the clinical representativeness and generalizability of treatments, practice guidelines, and future research directions.
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