Acceptance and Commitment Therapy versus Cognitive Behavior Therapy for Children With Anxiety: Outcomes of a Randomized Controlled Trial

Abstract

Acceptance and Commitment Therapy (ACT) has a growing empirical base in the treatment of anxiety among adults and children with other concerns. This study reports on the main outcomes of a randomized controlled trial of ACT and traditional cognitive behavioral therapy (CBT) in children with a Diagnostic and Statistical Manual of Mental Disorders (4th ed.) anxiety disorder. Participants were 193 children from urban Sydney, Australia, who were block-randomized to a 10-week group-based program of ACT or CBT or a 10-week waitlist control (WLC). Completers included 157 children (ACT = 54, CBT = 57, WLC = 46; M = 11 years, SD = 2.76; 78% Caucasian, 58% female). Pretreatment, posttreatment, and 3 months posttreatment assessments included clinician/self/parent-reported measures of anxiety, quality of life (QOL; anxiety interference, psychosocial and physical health-related QOL), and acceptance/defusion outcomes. Completer and intention-to-treat analyses revealed that ACT and CBT were both superior to WLC across outcomes, reflecting statistically and clinically significant differences, with gains maintained at 3 months posttreatment. Both completer and intention-to-treat analyses found ACT and CBT to produce similar outcomes. There was some support for ACT having greater effect sizes for QOL outcomes but not for avoidance/fusion. Although this study does not suggest that ACT is equivalent to CBT or should be adopted in its place, it does provide evidence that ACT might be another empirically supported treatment option for anxious youth. Further research is needed to replicate these findings.

Long Term Follow up in Children with Anxiety Disorders Treated with Acceptance and Commitment Therapy or Cognitive Behavioral Therapy: Outcomes and Predictors

“…AFQ-Y findings were in line with those emerging up to 3MFU, as previously reported [14], with both ACT and CBT having similarly positive outcomes. This supports the possibility that defusion and restructuring strategies are simply different tools that can be used to change behavior when problematic thoughts and feelings arise, rather than one being superior to the other.…”

“…Two randomized clinical trials of over 100 adults with anxiety found both ACT and CBT to be highly effective over time, with similar outcomes [12,13]. Hancock, et al [14] reported similar results in children and adolescents up to 3 months post-treatment.…”

“…Treatment was conducted by between two and four psychologists, dependent upon group numbers. Further details on both the treatments and their differences can be found in Swain, et al [29] and Hancock, et al [14]. Contact the authors for a program copy.…”

“…Follow up was performed for those in ACT and CBT only. Participants were recruited in Sydney, Australia via referrals from school counsellors, parents, word of mouth, and health professionals [14].…”

“…The present study furthers the research in this area by assessing the participants involved in the Hancock, et al [14] study, 2 years posttreatment. In addition, this study addresses the problem of treatment non-responders (up to 40%-50%, [16]) by investigating predictors of outcomes over time.…”