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The impact of treatment delivery format on response to cognitive behaviour therapy for preadolescent children with anxiety disorders

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  • Anna McKinnon, Department of Psychology, Centre for Emotional Health, Macquarie University, Sydney, NSW, Australia.
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  • Robert Keers, Department of Biological and Experimental Psychology, School of Biological and Chemical Sciences, Queen Mary University of London, London, UK.
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  • Jonathan R I Coleman, MRC Social Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London, 16 De Crespigny Park, London SE5 8AF, United Kingdom; NIHR Biomedical Research Centre for Mental Health, South London and Maudsley NHS Foundation Trust and Institute of Psychiatry, King's College London, London, United Kingdom.
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  • Kathryn J Lester, School of Psychology, University of Sussex, Brighton, UK.
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  • Susanna Roberts, Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, Denmark Hill, London, SE5 8AF, UK.
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  • Kristian Arendt
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  • Susan M Bögels, Research Institute Child Development and Education, University of Amsterdam, Amsterdam, The Netherlands.
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  • Peter Cooper, Department of Psychology, The University of Cape Town, Cape Town, South Africa.
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  • Cathy Creswell, School of Psychology and Clinical Language Sciences, University of Reading
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  • Catharina A Hartman, Interdisciplinary Center Psychopathology and Emotion Regulation, Department of Psychiatry, University Medical, Center Groningen, Groningen, The Netherlands.
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  • Krister W Fjermestad, Department of Child and Adolescent Psychiatry, Anxiety Disorders Research Network, Haukeland University Hospital, Bergen, Norway.
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  • Tina In-Albon, Department of Psychology, University Landau Koblenz, Landau, Germany.
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  • Kristen Lavallee, Department of Psychology, Ruhr-Universität Bochum, Bochum, Germany.
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  • Heidi J Lyneham, Department of Psychology, Centre for Emotional Health, Macquarie University, Sydney, NSW, Australia.
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  • Patrick Smith, Health Service & Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom.
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  • Richard Meiser-Stedman, Department of Psychology, University of East Anglia, Norwich, UK.
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  • Maaike H Nauta, Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, The Netherlands.
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  • Ronald M Rapee, Department of Psychology, Centre for Emotional Health, Macquarie University, Sydney, NSW, Australia.
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  • Yasmin Rey, Department of Psychology, Child Anxiety and Phobia Program, Florida International University, Miami, FL, USA.
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  • Silvia Schneider, Department of Psychology, Ruhr-Universität Bochum, Bochum, Germany.
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  • Wendy K Silverman, Child Study Center, School of Medicine, Yale University, New Haven, CT, USA.
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  • Mikael Thastum
  • Kerstin Thirlwall, School of Psychology and Clinical Language Sciences, University of Reading
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  • Gro Janne Wergeland, Department of Child and Adolescent Psychiatry, Anxiety Disorders Research Network, Haukeland University Hospital, Bergen, Norway.
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  • Thalia C Eley, MRC Social Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London, 16 De Crespigny Park, London SE5 8AF, United Kingdom; NIHR Biomedical Research Centre for Mental Health, South London and Maudsley NHS Foundation Trust and Institute of Psychiatry, King's College London, London, United Kingdom.
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  • Jennifer L Hudson, Department of Psychology, Centre for Emotional Health, Macquarie University, Sydney, NSW, Australia., Australien

BACKGROUND: Several delivery formats of cognitive behaviour therapy (CBT) for child anxiety have been proposed, however, there is little consensus on the optimal delivery format. The primary goal of this study was to investigate the impact of the child's primary anxiety diagnosis on changes in clinical severity (of the primary problem) during individual CBT, group CBT and guided parent-led CBT. The secondary goal was to investigate the impact of the child's primary anxiety diagnosis on rates of remission for the three treatment formats.

METHODS: A sample of 1,253 children (5-12 years; Mage = 9.3, SD = 1.7) was pooled from CBT trials carried out at 10 sites. Children had a primary diagnosis of generalised anxiety disorder (GAD), social anxiety disorder (SoAD), specific phobia (SP) or separation anxiety disorder (SAD). Children and parents completed a semistructured clinical interview to assess the presence and severity of DSM-IV psychiatric disorders at preintervention, postintervention and follow-up. Linear mixture modelling was used to evaluate the primary research question and logistic modelling was used to investigate the secondary research question.

RESULTS: In children with primary GAD, SAD or SoAD, there were no significant differences between delivery formats. However, children with primary SP showed significantly larger reductions in clinical severity following individual CBT compared to group CBT and guided parent-led CBT. The results were mirrored in the analysis of remission responses with the exception that individual CBT was no longer superior to group CBT for children with a primary SP. The difference between individual and group was not significant when follow-up data were examined separately.

CONCLUSIONS: Data show there may be greater clinical benefit by allocating children with a primary SP to individual CBT, although future research on cost-effectiveness is needed to determine whether the additional clinical benefits justify the additional resources required.

OriginalsprogEngelsk
TidsskriftJournal of Child Psychology & Psychiatry
Vol/bind59
Nummer7
Sider (fra-til)763-772
Antal sider10
ISSN0021-9630
DOI
StatusUdgivet - 2018

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