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

Abstract

Background Randomised controlled trials suggest that cognitive behavioural therapy (CBT) delivered by parents who are guided, in groups, by clinicians (Group GPD‐CBT) is an efficacious and potentially efficient treatment approach for child anxiety. The extent to which these results translate to routine settings is unclear. We evaluated Group GPD‐CBT as delivered in UK routine clinical services. Method Retrospective data regarding attendance and outcomes were routinely collected for 83 children whose parent(s) had attended Group GPD‐CBT. Semistructured interviews were conducted with 14 clinicians who had delivered Group GPD‐CBT. Results By 3–8 months (M = 5.22, SD = 1.17) post‐treatment, 70% of children were discharged or referred for support for other (non‐anxiety) conditions, without any further intervention for anxiety. Of the subset (N = 20) with available parent‐report symptom data, there was a significant decline in total anxiety score from pre‐ to post‐treatment. Clinician interviews were analysed using thematic analysis. This revealed that clinicians found Group GPD‐CBT to be acceptable and described it as a helpful, practical and empowering treatment for child anxiety. They highlighted additional benefits associated with group process factors (e.g. peer support, enhanced engagement), although noted that some, particularly anxious, parents were reluctant to attend a group format. Conclusions Results were promising regarding children's outcomes following Group GPD‐CBT delivered in routine practice. Group GPD‐CBT was viewed by clinicians as acceptable and helpful, and group process factors were seen to provide additional benefits. Some parents may find it difficult to attend a group format, suggesting that services should give careful consideration to how groups are presented and introduced to parents.

Evaluation of a parent‐led cognitive behaviour therapy programme in routine clinical practice: A controlled trial

“…These treatment gains were maintained at 3‐month follow‐up. The findings compare favourably to those reported in the only other report of a parent‐led CBT programme in routine clinical practice (Evans et al., 2019) and in other clinical trials (van der Sluis, van der Bruggen, Brechman‐Toussaint, Thissen, & Bögels, 2012) all of which reported medium effect sizes on parent‐reported scores of child anxiety. Those in the parenting group also reported significant reductions in general child behavioural difficulties as measured by the SDQ externalizing score.…”

“…(2020) argue that the development of gold standard treatment requires an improvement in their transition into routine clinical practice and for sustainable environments to support treatment delivery. Only one study to date has evaluated a group format of clinician‐guided parent‐delivered CBT for child anxiety in routine clinical practice and reported promising findings but was limited by lack of control group and a small sample size (Evans, Hill, O'Brien, & Creswell, 2019). The extant literature suggests that anxiety in young children can often be comorbid with associated behavioural difficulties (Cartwright‐Hatton et al., 2005; Cornacchio, Crum, Coxe, Pincus, & Comer, 2016).…”

Parents’ Perspectives on Guided Parent-Delivered Cognitive Behavioral Therapy for Childhood Anxiety Disorders: A Qualitative Study

“…The development of an in-depth understanding of parents' perspectives provides clear implications for both how GPD-CBT is introduced to parents (e.g., recognizing potential initial reticence) and areas for improvement in treatment delivery (e.g., further developments regarding how to set up less clear-cut exposures and increased flexibility in delivery methods). Overall, the findings from this study suggest that parents experience brief parent-led CBT as an acceptable and effective treatment for childhood anxiety disorders, adding to research suggesting that it may be an appropriate first-line intervention for childhood anxiety disorders (e.g., Evans et al, 2019;Rapee et al, 2017).…”

Increasing access to low‐intensity interventions for childhood anxiety: A pilot study of a guided self‐help program for Scandinavian parents

“…In this format, parents learn how to conduct treatment of their anxious child via therapist-guided sessions, workshops, and/or phone calls, and workbooks to use with the child at home. Overall, positive effects have been found for parent-delivered treatments (Cartwright-Hatton, McNally, Field et al, 2011;Evans, Hill, O'Brien & Creswell, 2018;Lebowitz, Omer, Hermes & Scahill, 2014). However, due to the various outcome measures utilized, it is difficult to make direct comparisons between studies.…”

“…However, due to the various outcome measures utilized, it is difficult to make direct comparisons between studies. For instance, in one study 32% of the children were reported to be free of all anxiety disorders following treatment (Cartwright-Hatton et al, 2011); in another study, 70% of the children did not require further support following treatment (Evans et al, 2018). A third study found 60% of the children to be rated as responders as they were "very much" or "much" improved on the Clinical Global Impression of Improvement (CGI-I) following treatment (Lebowitz et al, 2014).…”