Clinical outcomes and cost-effectiveness of brief guided parent-delivered cognitive behavioural therapy and solution-focused brief therapy for treatment of childhood anxiety disorders: a randomised controlled trial

Abstract

SummaryBackgroundHalf of all lifetime anxiety disorders emerge before age 12 years; however, access to evidence-based psychological therapies for affected children is poor. We aimed to compare the clinical outcomes and cost-effectiveness of two brief psychological treatments for children with anxiety referred to routine child mental health settings. We hypothesised that brief guided parent-delivered cognitive behavioural therapy (CBT) would be associated with better clinical outcomes than solution-focused brief therapy and would be cost-effective.MethodsWe did this randomised controlled trial at four National Health Service primary child and mental health services in Oxfordshire, UK. Children aged 5–12 years referred for anxiety difficulties were randomly allocated (1:1), via a secure online minimisation tool, to receive brief guided parent-delivered CBT or solution-focused brief therapy, with minimisation for age, sex, anxiety severity, and level of parental anxiety. The allocation sequence was not accessible to the researcher enrolling participants or to study assessors. Research staff who obtained outcome measurements were masked to group allocation and clinical staff who delivered the intervention did not measure outcomes. The primary outcome was recovery, on the basis of Clinical Global Impressions of Improvement (CGI-I). Parents recorded patient-level resource use. Quality-adjusted life-years (QALYs) for use in cost-utility analysis were derived from the Child Health Utility 9D. Assessments were done at baseline (before randomisation), after treatment (primary endpoint), and 6 months after treatment completion. We did analysis by intention to treat. This trial is registered with the ISCRTN registry, number ISRCTN07627865.FindingsBetween March 23, 2012, and March 31, 2014, we randomly assigned 136 patients to receive brief guided parent-delivered CBT (n=68) or solution-focused brief therapy (n=68). At the primary endpoint assessment (June, 2012, to September, 2014), 40 (59%) children in the brief guided parent-delivered CBT group versus 47 (69%) children in the solution-focused brief therapy group had an improvement of much or very much in CGI-I score, with no significant differences between groups in either clinical (CGI-I: relative risk 1·01, 95% CI 0·86–1·19; p=0·95) or economic (QALY: mean difference 0·006, −0·009 to 0·02; p=0·42) outcome measures. However, brief guided parent-delivered CBT was associated with lower costs (mean difference −£448; 95% CI −934 to 37; p=0·070) and, taking into account sampling uncertainty, was likely to represent a cost-effective use of resources compared with solution-focused brief therapy. No treatment-related or trial-related adverse events were reported in either group.InterpretationOur findings show no evidence of clinical superiority of brief guided parent-delivered CBT. However, guided parent-delivered CBT is likely to be a cost-effective alternative to solution-focused brief therapy and might be considered as a first-line treatment for children with anxiety problems....

Evaluation of a group format of clinician‐guided, parent‐delivered cognitive behavioural therapy for child anxiety in routine clinical practice: a pilot‐implementation study

“…Indeed, similar outcomes have been reported with approximately 5½ hr of clinician contact time in GPD‐CBT (e.g. Creswell et al., ) to those found in trials of 14 hr of individual child CBT (e.g. Piacentini et al., ).…”

“…This approach can be considered to be a low‐intensity treatment as it follows a ‘guided self‐help’ format in which parents are guided by a therapist in working through a book that describes how to apply CBT principles in their child's day to day life. This guided‐parent‐led approach requires considerably less clinician contact time than traditional individual child CBT for anxiety (Thirlwall et al., ) and is more cost‐effective than another brief psychological intervention for child anxiety (Creswell et al., ). Several trials have shown that GPD‐CBT is effective in reducing child anxiety (Creswell et al., ; Lyneham & Rapee, ; Thirlwall et al., ).…”

Innovations in the psychosocial treatment of youth with anxiety disorders: implications for a stepped care approach

“…Importantly, Lyneham and Rapee11 subsequently showed that when the self-help book was supplemented with direct support and guidance to the parents from a therapist, the recovery rates increased substantially. Furthermore, Creswell and colleagues12 as well as Cobham  et al 13 have recently shown positive outcomes for parent-delivered CBT interventions when supplemented by therapist support. For example, while brief, guided parent-delivered CBT was not superior to brief solution-focused therapy for child anxiety (n=136, 5–12 years) across four community mental health clinics in the UK, findings did support cost-effectiveness of the brief, guided parent-delivered CBT, suggesting this approach may be an appropriate, effective first-line treatment in National Mental Health Services.…”

Brief guided parent-delivered CBT is both efficacious andcost-effective for childhood anxiety disorders

“…To date, however, little research has assessed the efficacy of shorter forms of CBT nor has there been much exploration of the cost-effectiveness of treatments for anxiety disorders in children and adolescents. This randomised controlled trial2 compared two brief treatments on efficacy and cost-effectiveness in the treatment of childhood anxiety disorders.…”