A Randomized Controlled Trial in Community Mental Health Centers of Computer-Assisted Cognitive Behavioral Therapy Versus Treatment as Usual for Children With Anxiety

Storch, Eric A.; Salloum, Alison; King, A B A Morgan; Crawford, Alexandra; Andel, Ross; McBride, Megan; Lewin, Adam B.

doi:10.1002/da.22399

Cited by 57 publications

(55 citation statements)

References 57 publications

(112 reference statements)

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“…Replicating previous methodology (e.g., Tolin et al 2005;Storch et al 2010;Lewin et al 2011;Storch et al 2011;Caporino et al 2013;Farris et al 2013;Jeon et al 2013;Johnco et al 2015), we conducted signal detection analyses using ROC procedures to identify optimal cutoffs for identifying treatment response and remission on the PARS5 and PARS6. Consistent with existing definitions (e.g., Tolin et al 2005;Lewin et al 2011;Storch et al 2011;Caporino et al 2013;Farris et al 2013;Jeon et al 2013;Johnco et al 2015), participants were classified as treatment responders if they scored ''much'' or ''very much'' improved on the CGI-I at posttreatment.…”

Section: Discussionmentioning

confidence: 99%

“…See Storch et al (2015) for a full description of the study protocol. Participants were recruited from three community mental health centers in North, Central, and South Florida.…”

Section: Participantsmentioning

confidence: 99%

“…Treatment components include psychoeducation about anxiety, identifying and dealing with anxious cognitions, problem solving, and graded exposure. This program has demonstrated efficacy for pediatric anxiety, with studies reporting remission rates of 53-81% using the CCAL treatment, and durability of treatment gains at 1 and 3 month follow-up (Khanna and Kendall 2010;Storch et al 2015).…”

Section: Treatmentmentioning

confidence: 99%

“…However, extension of signal detection analyses to provide guidelines for defining response and remission based on the PARS5 are clearly warranted, given that the majority of clinical and pharmacological studies utilize the PARS5 score (RUPP 2001, RUPP 2002Geller et al 2007;Rynn et al 2007;Ginsburg et al 2011;Storch et al 2013Storch et al , 2015. Given that the PARS5 and PARS6 may have different utility and relevance for clinicians and researchers in different contexts, the availability and comparison of guidelines across these scores are important for user flexibility.…”

Section: Introductionmentioning

confidence: 99%

“…Based on methods used in numerous signal detection studies (e.g., Tolin et al 2005;Storch et al 2010;Lewin et al 2011;Storch et al 2011;Caporino et al 2013;Farris et al 2013), this study aimed to use receiver operating characteristic (ROC) procedures to examine optimal guidelines for defining treatment response and remission of anxiety symptoms based on the PARS5 and to replicate existing guidelines using the PARS6. We hypothesized that existing recommendations (Caporino et al 2013) for defining response and remission on the PARS6 would be replicated.…”

Section: Introductionmentioning

confidence: 99%

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Refining Clinical Judgment of Treatment Response and Symptom Remission Identification in Childhood Anxiety Using a Signal Detection Analysis on the Pediatric Anxiety Rating Scale

Johnco

Salloum

Lewin

et al. 2015

Journal of Child and Adolescent Psychopharmacology

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Objective: The purpose of this study was to determine guidelines for delineating treatment response and symptom remission for children with anxiety disorder based on the five item and Pediatric Anxiety Rating Scale (PARS5), and replicate guidelines using the six item PARS (PARS6). Methods: Participants were 73 children 7-13 years of age with a primary anxiety disorder who received computer-assisted cognitive behavioral therapy for anxiety. Signal detection analyses utilizing receiver operating curve procedures were used to determine optimal guidelines for defining treatment response and symptom remission for youth with anxiety disorders on the PARS5 and PARS6. The percent reduction in anxiety severity was used to predict treatment responder status. The percent reduction in symptoms and posttreatment raw score were used to predict remission status. Results: Optimal prediction of treatment response based on gold standard criteria was achieved at 15-20% reduction in symptoms on the PARS5 (with 20% reduction achieving marginally higher accuracy), and 20% reduction on the PARS6. A 25% reduction in symptoms on the PARS5 or a posttreatment raw score cutoff of 9 optimally predicted remission status. For the PARS6, a cutoff of 35% reduction or a posttreatment score of 11, was considered optimal for determining remission in clinical settings, whereas a 30% reduction or score of 12 was considered optimal for research settings. Conclusions: With different scoring options available for the PARS, these results provide guidelines for determining response and remission based on the PARS5 and PARS6 scores. Guidelines have implications for use in clinical trials, as well as for assessment of change in clinical practice.

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Section: Discussionmentioning

confidence: 99%

“…See Storch et al (2015) for a full description of the study protocol. Participants were recruited from three community mental health centers in North, Central, and South Florida.…”

Section: Participantsmentioning

confidence: 99%

Section: Treatmentmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Refining Clinical Judgment of Treatment Response and Symptom Remission Identification in Childhood Anxiety Using a Signal Detection Analysis on the Pediatric Anxiety Rating Scale

Johnco

Salloum

Lewin

et al. 2015

Journal of Child and Adolescent Psychopharmacology

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Integrating evidence‐based assessment into clinical practice for pediatric anxiety disorders

et al. 2019

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Background: Although evidence-based assessments are the cornerstone of evidencebased treatments, it remains unknown whether incorporating evidence-based assessments into clinical practice enhances therapists' judgment of therapeutic improvement. This study examined whether the inclusion of youth-and parent-reported anxiety rating scales improved therapists' judgment of treatment response and remission compared to the judgment of treatment-masked independent evaluators (IEs) after (a) weekly/biweekly acute treatment and (b) monthly follow-up care. Methods: Four hundred thirty six youth received cognitive-behavioral therapy (CBT), medication, CBT with medication, or pill placebo through the Child/Adolescent Anxiety Multimodal Study. Participants and parents completed the following anxiety scales at pretreatment, posttreatment, and follow-up: Screen for Childhood Anxiety and Related Disorders (SCARED) and Multidimensional Anxiety Scale for Children (MASC). IEs rated anxiety on the Clinical Global Impression of Severity (CGI-S) and Improvement (CGI-I) at posttreatment and follow-up. Therapists rated anxiety severity and improvement using scales that paralleled IE measures.Results: Fair-to-moderate agreement was found between therapists and IEs after acute treatment (κ = 0.38-0.48), with only slight-to-fair agreement found after follow-up care (κ = 0.07-0.33). Optimal algorithms for determining treatment response and remission included the combination of therapists' ratings and the parent-reported SCARED after acute (κ = 0.52-0.54) and follow-up care (κ = 0.43-0.48), with significant improvement in the precision of judgments after follow-up care (p < .02-.001). Conclusion:Therapists are good at detecting treatment response and remission, but the inclusion of the parent-report SCARED optimized agreement with IE rating-especially when contact was less frequent. Findings suggest that utilizing parent-report measures of anxiety in clinical practice improves the precision of therapists' judgment. K E Y W O R D Sadolescents, anxiety disorders, assessment, children, evidence-based assessment

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Potential mechanisms of change in cognitive behavioral therapy for childhood anxiety: A meta‐analysis

Luo

McAloon

2020

Depression and Anxiety

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Cognitive‐behavioral therapy (CBT) is regarded as an effective treatment for anxiety disorders in childhood. Researchers have begun to investigate potential mechanisms of change that drive these positive outcomes, including shifts in cognitions, behavior, and affect. However, few studies have established the mediational effects of these factors as a proxy for establishing mechanistic change. This meta‐analysis attempts to synthesize the literature on potential mechanisms of change in CBT for childhood anxiety and investigates the mediational effects of these factors on treatment outcomes. Seventeen studies met the inclusion criteria. Across studies, five potential mediators were identified: externalizing difficulties, negative self‐talk, coping, fear, and depression. Results indicated that CBT was effective in improving outcomes on all potential mediators, except for fear. Mediational analyses showed that externalizing difficulties, negative self‐talk, coping, and depression mediated anxiety following treatment. Fear did not mediate the relationship. Implications for future mechanisms of change research are proposed.

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A Randomized Controlled Trial in Community Mental Health Centers of Computer-Assisted Cognitive Behavioral Therapy Versus Treatment as Usual for Children With Anxiety

Abstract: Within the limitations of this study, computer-assisted CBT is an effective and feasible treatment for anxious children when used in community mental health centers by CBT-naïve clinicians.

Cited by 57 publications

References 57 publications

Refining Clinical Judgment of Treatment Response and Symptom Remission Identification in Childhood Anxiety Using a Signal Detection Analysis on the Pediatric Anxiety Rating Scale

Refining Clinical Judgment of Treatment Response and Symptom Remission Identification in Childhood Anxiety Using a Signal Detection Analysis on the Pediatric Anxiety Rating Scale

Integrating evidence‐based assessment into clinical practice for pediatric anxiety disorders

Potential mechanisms of change in cognitive behavioral therapy for childhood anxiety: A meta‐analysis

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