The Effectiveness of Psychological Therapies for Anxiety Disorders in Adolescents: A Meta-Analysis

Abstract

Anxiety disorders are common in adolescence but outcomes for adolescents are unclear and we do not know what factors moderate treatment outcome for this age group. We conducted meta-analyses to establish the effectiveness of psychological therapies for adolescent anxiety disorders in (i) reducing anxiety disorder symptoms, and (ii) remission from the primary anxiety disorder, compared with controls, and examine potential moderators of treatment effects. The protocol was registered with PROSPERO (CRD42018091744). Electronic databases (Web of Science, MEDLINE, Psycinfo, EMBASE) were searched from January 1990 to December 2019. 2511 articles were reviewed, those meeting strict criteria were included. Random effects meta-analyses were conducted. Analyses of symptom severity outcomes comprised sixteen studies (CBT k = 15, non-CBT k = 1; n = 766 adolescents), and analyses of diagnostic remission outcomes comprised nine (CBT k = 9; n = 563 adolescents). Post-treatment, those receiving treatment were significantly more likely to experience reduced symptom severity (SMD = 0.454, 95% CI 0.22–0.69) and remission from the primary anxiety disorder than controls (RR = 7.94, 95% CI 3.19–12.7) (36% treatment vs. 9% controls in remission). None of the moderators analysed were statistically significant. Psychological therapies targeting anxiety disorders in adolescents are more effective than controls. However, with only just over a third in remission post-treatment, there is a clear need to develop more effective treatments for adolescents, evaluated through high-quality randomised controlled trials incorporating active controls and follow-up data.

Cognitive Behavioral Therapy for Anxiety Disorders in Youth: Efficacy, Moderators, and New Advances in Predicting Outcomes

“…In terms of treatment characteristics, parent involvement in treatment has been theorized to improve outcomes, but there is more limited evidence in support of this. In one metaanalysis comparing CBT to other psychotherapies for adolescents, parent involvement was not a significant moderator of outcomes [25]. Additionally, a meta-analysis (N = 964) that compared individual CBT to parent-involved CBT for anxious children and adolescents did not find a significant difference on youth anxiety symptoms (Tau 2 = 0.02, p = 0.59) [32].…”

“…First, there is considerable variability in the amount and type of parent involvement [9], which may make it difficult to assess specific aspects of having family in treatment that enhance outcomes for youth. Older participants may not need as much parent involvement in treatment as younger children, which could explain why a metaanalysis with adolescents did not find parent involvement to be a significant moderator of outcomes [25]. Additionally, CBT with parent involvement may offer fewer opportunities for in-session exposures and thus may be associated with smaller effects at posttreatment for some youth, as found in one meta-analysis [9].…”

“…For example, little evidence suggests that age or gender moderates the effects of treatment on anxiety outcomes. A recent meta-analysis (N = 766) compared CBT and non-CBT psychological therapies to active and passive controls and found that age and gender were not significant moderators of treatment effects on anxiety symptom severity in adolescents [25]. Another meta-analysis (N = 535) found that relapse rates were higher among younger samples, but gender did not differentially predict relapse rates in youth [14•].…”

“…Another meta-analysis (N = 535) found that relapse rates were higher among younger samples, but gender did not differentially predict relapse rates in youth [14•]. Research examining relapse rates based on race and ethnicity is more mixed; one meta-analysis found a positive association between percent of racial/ethnic minority participants in a sample and relapse rates [14•], while another did not find evidence that ethnicity moderated treatment outcome [25].…”

“…Although various clinical characteristics can inform case conceptualization, it remains unclear if they are robustly linked with treatment outcome. For example, recent metaanalyses have found limited evidence that primary diagnosis moderates the effect of treatment on symptoms measured at posttreatment [25] or at the first follow-up (average follow-up period being 11.06 months posttreatment) [14•]. However, children and adolescents with a primary diagnosis of social anxiety disorder were significantly less likely to recover following CBT (35% recovery rate) compared to those with any other primary anxiety disorder diagnosis (54% recovery rate) (N = 635; no significant heterogeneity, I 2 = 0%) [26].…”