A Systematic Review of Parental Involvement in Cognitive Behavioural Therapy for Adolescent Anxiety Disorders

Cardy, Jessica; Waite, Polly; Cocks, Francesca; Creswell, Cathy

doi:10.1007/s10567-020-00324-2

Cited by 32 publications

(27 citation statements)

References 44 publications

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“…Nevertheless, considering the findings of Bennett et al [ 16 ], parent-involved self-help interventions may be more useful than predominantly self-administered interventions; the inclusion of parental involvement alongside self-help interventions may overcome some of the aforementioned barriers to interventions while retaining young person engagement, compliance, and increasing the effectiveness of the intervention. This is in line with evidence that parent-involved multimedia and bibliotherapy interventions are as beneficial for behavioral disorders as therapist-led interventions in the long term [ 89 ] and that parent involvement within CBT interventions is effective for adolescent anxiety disorders [ 90 ]. This area of research warrants further investigation as the digital delivery of parent training could facilitate access to these interventions.…”

Section: Discussionsupporting

confidence: 84%

Self-help Digital Interventions Targeted at Improving Psychological Well-being in Young People With Perceived or Clinically Diagnosed Reduced Well-being: Systematic Review

Babbage¹,

Jackson²,

Davies³

et al. 2022

JMIR Ment Health

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Background Levels of well-being are declining, whereas rates of mental health problems remain high in young people. The World Health Organization defines mental health as not merely the absence of mental disorder but also includes social and psychological well-being as integral to positive mental health, highlighting that mental health is applicable to young people with mental health conditions and those without a diagnosis of a mental health condition. Reduced mental well-being have been identified in studies of young people with clinical populations, as well as in populations consisting of nonclinical young people. Self-help digital interventions can be delivered at mass at a low cost and without the need for trained input, thereby facilitating access to support for well-being. Self-help interventions are effective in young people with mental health conditions, but systematic reviews of such studies have been limited to randomized controlled trials, have not included reduced well-being as an inclusion criterion, and do not consider engagement factors such as retention. Objective The objective of this study was to systematically review all controlled studies of digitally delivered, self-administered interventions for young people aged 9 to 25 years, with perceived or clinically diagnosed reduced psychological well-being. Participant retention and effectiveness of the interventions were also explored. Methods A systematic search of the PsycInfo, EMBASE, Cochrane, Scopus, and MEDLINE databases from inception to 2021, reference searches of relevant papers, and gray literature was carried out for digitally controlled studies conducted with young people with perceived or clinically diagnosed reduced well-being, aimed at improving psychological well-being. Data were extracted to identify the effectiveness and retention rates of the interventions and the quality of the studies. Results Overall, 1.04% (12/1153) of studies met the inclusion criteria: 83% (10/12) of studies were randomized controlled trials and 17% (2/12) were controlled pre-post studies. Most (6/12, 50%) studies aimed to improve symptoms of depression; 3 interventions aimed at both anxiety and depressive symptoms and 2 studies aimed at improving social functioning difficulties. Owing to the high risk of bias across interventions and lack of similar outcome measures, a meta-analysis was not conducted. Retention rates across studies were regarded as good, with moderate to high retention. Overall, the findings indicated that predominantly self-administered self-help interventions improved well-being in the areas targeted by the intervention and identified additional areas of well-being that were positively affected by interventions. Few interventions supported psychological well-being that was different from those used by young people with a clinical diagnosis of mental illness or young people from neurodiverse backgrounds. Conclusions The findings, along with the advantages of self-help interventions, highlight the need for upscaling self-help interventions to better support vulnerable populations of young people who experience poor psychological well-being. Trial Registration PROSPERO CRD42019129321; https://tinyurl.com/4fb2t4fz

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Section: Discussionsupporting

confidence: 84%

Self-help Digital Interventions Targeted at Improving Psychological Well-being in Young People With Perceived or Clinically Diagnosed Reduced Well-being: Systematic Review

Babbage¹,

Jackson²,

Davies³

et al. 2022

JMIR Ment Health

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“…However, receiving professional support alongside computerized therapies might be beneficial, such that blended approaches could be optimal [ 57 ]. In addition, parental involvement in child CBT may lead to better outcomes, although evidence on their role in adolescent CBT is less conclusive [ 58 , 59 ]. Few of the studies we identified described direct parental involvement in the cCBT intervention; for those that did, the extent of parental involvement was minimal and sometimes optional.…”

Section: Discussionmentioning

confidence: 99%

Computerized Cognitive Behavioral Therapy for Treatment of Depression and Anxiety in Adolescents: Systematic Review and Meta-analysis

Wickersham¹,

Barack²,

Cross³

et al. 2022

J Med Internet Res

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Background Depression and anxiety are major public health concerns among adolescents. Computerized cognitive behavioral therapy (cCBT) has emerged as a potential intervention, but its efficacy in adolescents remains unestablished. Objective This review aimed to systematically review and meta-analyze findings on the efficacy of cCBT for the treatment of adolescent depression and anxiety. Methods Embase, PsycINFO, and Ovid MEDLINE were systematically searched for randomized controlled trials in English, which investigated the efficacy of cCBT for reducing self-reported depression or anxiety in adolescents aged 11 to 19 years. Titles, abstracts, and full texts were screened for eligibility by 2 independent researchers (TB and LC). A random-effects meta-analysis was conducted to pool the effects of cCBT on depression and anxiety symptom scores compared with the control groups. Study quality was assessed using the Cochrane Collaboration Risk of Bias tool. Results A total of 16 randomized controlled trials were eligible for inclusion in this review, of which 13 (81%) were included in the meta-analysis. The quality of the studies was mixed, with 5 (31%) studies rated as good overall, 2 (13%) rated as fair, and 9 (56%) rated as poor. Small but statistically significant effects of cCBT were detected, with cCBT conditions showing lower symptom scores at follow-up compared with control conditions for both anxiety (standardized mean difference −0.21, 95% CI −0.33 to −0.09; I2=36.2%) and depression (standardized mean difference −0.23, 95% CI −0.39 to −0.07; I2=59.5%). Secondary analyses suggested that cCBT may be comparable with alternative, active interventions (such as face-to-face therapy or treatment as usual). Conclusions This meta-analysis reinforces the efficacy of cCBT for the treatment of anxiety and depression and is the first to examine this exclusively in adolescents. Future research could aim to identify the active components of these interventions toward optimizing their development and increasing the feasibility and acceptability of cCBT in this age group. Trial Registration PROSPERO CRD42019141941; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=141941

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“…While a recent meta-analysis was unable to determine whether parental involvement enhanced treatment outcomes for adolescent anxiety (Cardy et al, 2020), parental supervision and support has been shown to significantly improve treatment adherence in youth (Wahlund et al, 2021). In past interventions (Cardy et al, 2020), parental involvement has ranged from individual treatment sessions for parents, parental participation in adolescent sessions, or hard copy workbooks for parental completion. To our knowledge, no studies have examined parental involvement in smartphone-delivered CBT interventions for adolescents.…”

Section: Differences In Preferences Between Adolescents Parents and M...mentioning

confidence: 99%

“…However, to capitalise on the potential of digital health interventions in addressing treatment gaps, it is critical to also include those supporting adolescent care in the co-design process. For example, in-person CBT programs commonly involve parents suggesting a CBT smartphone intervention may benefit from parental involvement (Cardy et al, 2020). Furthermore, involving parents in the design of a smartphone app is particularly relevant for addressing concerns around excessive screen time and its potential negative impacts on mental health (Twenge and Campbell, 2019).…”

Section: Introductionmentioning

confidence: 99%

A cognitive behavioural therapy smartphone app for adolescent depression and anxiety: co-design of ClearlyMe

Achilles

Spanos

et al. 2022

tCBT

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Adolescence is associated with heightened vulnerability to symptoms of depression and anxiety. In-person and computerised cognitive behavioural therapy (CBT) are effective treatment options, yet uptake and engagement remain low. Smartphone delivery of CBT offers an alternative, highly accessible method of delivering CBT. However, there is no freely available CBT smartphone application (app) specifically designed to reduce depression and anxiety symptoms in adolescents. The aim of this study was to design a new CBT smartphone app (ClearlyMe) that targets depressive and anxiety symptoms in adolescents. We engaged in a rigorous co-design process with adolescents (n=36), parents (n=15), and mental health professionals (n=32). Co-design involved: (1) discovery of users’ needs, views and preferences by conducting focus groups, (2) defining app features through ideation workshops and user consultations, (3) designing therapeutic CBT content and visual features, and (4) testing prototypes. Users were involved at every step and the process was iterative, with findings carried forward to ensure continued refinement of concepts and features. We found a preference for vibrant, cheerful colours and illustrations and non-endorsement of gamification and chatbots, which contrasted with findings from other studies. Preferences were largely consistent between the three user groups. However, adolescents preferred an app that could be used autonomously without professional support, whereas mental health professionals desired a product for use as a therapy adjunct to support CBT skill development. The importance of co-design, and particularly the inclusion of all stakeholders throughout the entire co-design process, is discussed in relation to the design of ClearlyMe. Key learning aims (1) To understand the co-design process that underpins the development of a new CBT smartphone app for youth with elevated symptoms of depression and anxiety. (2) To understand adolescent, parent and mental health professionals’ key preferences regarding the features and functionality of a CBT smartphone app for adolescents with elevated symptoms of depression and anxiety. (3) To understand how ClearlyMe has been designed as both a therapy adjunct and stand-alone program, and how it can be incorporated into day-to-day clinical practice.

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A Systematic Review of Parental Involvement in Cognitive Behavioural Therapy for Adolescent Anxiety Disorders

Cited by 32 publications

References 44 publications

Self-help Digital Interventions Targeted at Improving Psychological Well-being in Young People With Perceived or Clinically Diagnosed Reduced Well-being: Systematic Review

Self-help Digital Interventions Targeted at Improving Psychological Well-being in Young People With Perceived or Clinically Diagnosed Reduced Well-being: Systematic Review

Computerized Cognitive Behavioral Therapy for Treatment of Depression and Anxiety in Adolescents: Systematic Review and Meta-analysis

A cognitive behavioural therapy smartphone app for adolescent depression and anxiety: co-design of ClearlyMe

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