Feasibility of two modes of treatment delivery for child anxiety in primary care

Abstract

In this study, we examine the feasibility of cognitive behavior therapy (CBT) for children with anxiety in primary care, using two modes of treatment delivery. A total of 48 parents and youth (8–13) with anxiety disorders were randomly assigned to receive 10-sessions of CBT either delivered by a child anxiety specialist in the primary care clinic or implemented by the parent with therapist support by telephone (i.e., face-to-face or therapist-supported bibliotherapy). Feasibility outcomes including satisfaction, barriers to treatment participation, safety, and dropout were assessed. Independent evaluators, blind to treatment condition, administered the Anxiety Disorders Interview Schedule for Children (ADIS) and the Clinical Global Impression of Improvement (CGI-I) at baseline, post-treatment and 3-month follow-up; clinical self-report questionnaires were also administered. Findings revealed high satisfaction, low endorsement of barriers, low drop out rates, and no adverse events across the two modalities. According to the CGI-I, 58.3%–75% of participants were considered responders (i.e., much or very much improved) at the various time points. Similar patterns were found for remission from “primary anxiety disorder” and “all anxiety disorders” as defined by the ADIS. Clinically significant improvement was seen on the various parent and child self-report measures of anxiety. Findings suggest that both therapy modalities are feasible and associated with significant treatment gains in the primary care setting.

Recent developments in the treatment of anxiety disorders in children and adolescents

“…Typically, these studies have found outcomes that are similar to those found in trials of more intensive CBT (eg, 76% ‘much/very much improved’ following only 5.5 hours of therapist support, compared with 25% in the wait-list condition; NNT=2) 36. Notably, this approach has been found to be effective even when delivered by non-specialists36 and feasible within UK and US primary care services37 38 suggesting that this may be a cost-effective means to improve access to evidence-based treatments for children with anxiety disorders.…”

An Open Trial of the Anxiety Action Plan (AxAP): A Brief Pediatrician-Delivered Intervention for Anxious Youth

“…For instance, Kozlowski et al (2015) examined preliminary outcomes of a seven session nurse-delivered intervention for anxiety in a primary care setting and found a 13.88 point reduction on the child-report SCARED (means were 40.88 and 27 at pre and post-test respectively; Cohen's d = .77). Similarly, Chavira and colleagues (2014) reported data on the SCARED for two modes of pediatric anxiety treatment (i.e., 10 sessions face to face with a mental health clinician or clinician supported bibliotherapy). While there were no treatment group differences, both groups showed over an 18 point reduction on the parent-report SCARED.…”

“…To date, efforts to reduce anxiety in primary care settings have focused on using mental health care specialists or nurses, and interventions have generally employed cognitive behavioral therapy (CBT) strategies over seven or more sessions, with the exception of bibliotherapy interventions which are shorter in duration (Chavira et al, 2014; Kozlowski, Lusk, & Melnyk, 2015). The small number of published studies evaluating interventions aimed at reducing pediatric anxiety in primary care settings have reported positive findings, with response rates between 34 and 75% (Chavira et al, 2014; Creswell et al, 2010; Kolko et al, 2010; McGrath et al, 2011; Thirlwall et al, 2013; Warner et al, 2011).…”

“…The small number of published studies evaluating interventions aimed at reducing pediatric anxiety in primary care settings have reported positive findings, with response rates between 34 and 75% (Chavira et al, 2014; Creswell et al, 2010; Kolko et al, 2010; McGrath et al, 2011; Thirlwall et al, 2013; Warner et al, 2011). …”

Guided parent-delivered cognitive behavioral therapy for childhood anxiety: Predictors of treatment response

“…This approach involves parents being guided in implementing CBT strategies in their child’s day to day life and has been shown to be an effective treatment for anxiety disorders in children (Chavira, Drahota, & Garland, 2014; Lyneham and Rapee, 2006, Smith et al, 2014, Thirlwall et al, 2013) with similar outcomes to those found from more intensive CBT delivered face to face with children and parents (Chavira et al, 2014; Cobham, 2012; Leong, Cobham, & De Groot, 2009). As such, GPD-CBT lends itself well to a possible ‘stepped care’ service model, in which low-intensity treatments, which use substantially fewer resources than conventional treatments (Salloum, 2010), are routinely administered and more intensive treatments are reserved for those who may require more specialist input (Bower & Gilbody, 2005).…”