Cognitive-Behavioral Group Therapy for Youths with Anxiety Disorders in the Community: Effectiveness in Low and Middle Income Countries

Abstract

Background: Although cognitive-behavioral therapy (CBT) is established as a first line treatment for anxiety disorders in children and adolescents, there is little evidence about the effectiveness of CBT protocols in cases identified in the community in low and middle income countries (LaMICs). Aims: To evaluate the effectiveness of group CBT protocol for youths with anxiety disorders identified in a community sample in LaMICs. Method: A total of 14 sessions of group CBT for youths and 2 concurrent sessions for parents based on Kendall's Coping Cat program were offered. Participants were selected from a crosssectional community study; 45 subjects fulfilled inclusion criteria and 28 agreed to participate in the open clinical trial. Treatment effectiveness was evaluated with standard clinical, selfand parent-rated measures of anxiety, depression, externalizing symptoms and quality of life (QoL). Results: Twenty youths completed the protocol. All scales showed an improvement of anxiety and reduction in externalizing symptoms over time, with a moderate to large effect size (d = 0.59 to 2.06; p < .05), but not in depressive symptoms or QoL. Conclusions: Consistent with previous evidence, group CBT is effective in treating anxiety disorders in youths. Results encourage further randomized clinical trials using CBT protocols adapted and developed to be used in LaMICs.

Mental health challenges among adolescents living with HIV

“…Similarly, community-based interventions also showed significant improvements in youth mental health and social wellbeing [84]. Cognitive-behavioural group therapy has been shown to improve externalizing symptoms and anxiety in low- and middle-income countries, though not depressive symptoms or quality of life [85]. Very few mental health interventions have been studied specifically for HIV-infected adolescents in RLS.…”

Applying a developmental approach to quality of life assessment in children and adolescents with psychological disorders: challenges and guidelines

“…As shown in Table 2, studies examining the QL of children with the following diagnoses of mental disorder were included: attention deficit hyperactivity disorder (ADHD; n = 27) [18; 32-57]; autism spectrum disorder (n = 10) [58][59][60][61][62][63][64][65][66][67]; Gilles de la Tourette syndrome or other tic disorder (n = 6) [68][69][70][71][72][73]; bipolar spectrum disorders (n = 5) [74][75][76][77][78]; enuresis (n = 3) [79][80][81]; separation anxiety disorder and anxiety disorders (n = 3) [82][83][84]; eating disorders (n = 2) [85][86]; major depressive disorder (n = 2) [87][88]; conduct disorder (n = 1) [89]; obsessive-compulsive disorder (n = 1) [24]; and learning disabilities (n = 1) [90]. Five studies included diverse diagnoses of a mental disorder [13-14, 23, 91-92].…”

“…The reviewed studies were conducted in several countries, including the US (n = 26) [24, 32-33, 37, 43, 45-47, 51, 53, 59-60, 63-64, 67-68, 72-74, 76-78, 86-87, 89, 91]; Germany (n = 6) [40,44,48,54,79,92]; Switzerland (n = 3) [23, 82,84]; the Netherlands (n = 4) [13,38,52,66]; Australia (n = 3) [14,[49][50]; Turkey (n = 3) [41,61,80]; Brazil (n = 2) [39,83]; Spain (n = 2) [36,85]; Italy (n = 2) [70,71]; Taiwan (n = 2) [55][56]; Iran (n = 1) [42]; UK (n = 1) [69]; Norway (n = 1) [35]; Hungary (n = 1) [88]; France (n = 1) [58]; Canada (n = 1) [18]; Japan (n = 1) [81]; Greece (n = 1) [90]; and Mexico (n = 1) [57]. Four studies were conducted in two or more countries [34,62,65,75].…”

“…Only three (5%) studies used instruments developed to assess QL in adult populations (SF-36 and EuroQoL-5D) [66,[85][86]. Among the studies that used age-appropriate instruments, the majority assessed multiple dimensions of QL (n = 52; 83%) [13-14, 49,52,60,73,84,87,89], and two (3%) studies did not provide information about the instruments' dimensions used in the study [82][83].…”

“…Age categories were defined according to the MeSH terms: preschoolers (2-5 years), children (6-12 years), and adolescents (13-18 years). As presented in Figure 2, no study included only preschoolers, 11 (17%) studies included children Considering all studies in the present review (see Figure 3), approximately half of the studies did not report whether and/or how age was statistically treated (n = 34; 52%) [ [34,40,48,77], compared QL scores between age groups (n = 6; 9%) [13, 24, 61-62, 72, 87], introduced age as a covariate in comparison analyses (n = 8; 12%) [45,47,51,54,59,65,70,83], or analyzed age as a predictor in regression analyses (n = 10; 15%) [14,18,46,50,55,66,68,78,88,91].…”