Disorders - Anxiety Disorders
Ipser, J. C., Stein, D. J., Hawkridge, S., Hoppe, L.
Background: Anxiety disorders are a potentially disabling group of disorders which are prevalent in childhood and adolescence. The recognition of the early onset of anxiety disorders, and their successful treatment with medication in adults, has led to the growing interest in using medication for paediatric anxiety disorders. Objectives: To assess the efficacy and tolerability of medication for treating paediatric anxiety disorders. Search strategy: We searched the Cochrane Depression, Anxiety & Neurosis Group specialised register (CCDANCTR-Studies), MEDLINE (via PubMed 1966 to August 2008), EMBASE (1966 to August 2008), and PsycINFO (1972 to August 2008). Various electronic registers were searched for unpublished studies. Reference lists of retrieved articles were searched for additional studies. Selection criteria: All randomised controlled trials (RCTs) of pharmacotherapy in childhood/adolescent anxiety disorders. Data collection and analysis: Two raters independently assessed RCTs for inclusion in the review, collated trial data, and assessed trial quality. Investigators were contacted to obtain missing data. Summary statistics were stratified by medication class, and by medication agent for the selective serotonin reuptake inhibitors (SSRIs). Dichotomous and continuous measures were calculated using a random effects model, heterogeneity was assessed, and subgroup/sensitivity analyses were undertaken. Main results: 22 short-term (<= 16 weeks) RCTs were included in the analysis (2519 participants). The majority of the trials assessed the efficacy of the SSRIs (N = 15). Medication and placebo response occurred in 58.1% and 31.5% of patients, respectively (Number of studies (N) = 14, Number needed to treat (NNT) = 4). Medication was more effective than placebo in reducing overall symptom severity in OCD in a post-hoc comparison (N = 7, Weighted Mean Difference (WMD) = -4.45, 95%CI = -5.94, -2.97, n = 765). Medication was less well tolerated than placebo overall, though the absolute proportion of participants who withdrew due to drug-related adverse events was low (4.9%). Authors' conclusions: Medication treatments can be effective in paediatric anxiety disorders, acting to reduce core symptoms, and should be considered as part of the treatment of these disorders. The greatest number of trials showing efficacy to date have assessed the SSRIs in treating paediatric OCD. There is no clear evidence to show that any particular class of medication is more effective or better tolerated than any other. As quantitative data was only available for the SSRIs and venlafaxine the routine use of benzodiazepines cannot be recommended, especially given concerns of dependency and treatment -related emergent adverse events associated with this class of drugs. Future RCTs could help identify potential clinical moderators of treatment efficacy. Studies of the long-term efficacy of medication treatment, optimal dosage, as well as direct comparisons of pharmacotherapy and psychotherapy are also warranted. Copyright (copyright) 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Cochrane Database of Systematic Reviews, (3) :
- Year: 2009
- Problem: Anxiety Disorders (any)
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
Kraag, G., VanBreukelen, G. J. P., Kok, G., Hosman, C.
Background: This study examined the effects of a universal stress management program (Learn Young, Learn Fair) on stress, coping, anxiety and depression in fifth and sixth grade children. Methods: Fifty-two schools (1467 children) participated in a clustered randomized controlled trial. Data was collected in the fall of 2002, the spring of 2003, and the winter of 2004. Given the nested structure of the design mixed (multilevel) regression analyses were applied. Results: Positive effects were found for emotion-focused coping at posttest (p <.01) and increased stress awareness at both time points. At posttest a decrease in problem solving was found (p <.01). After correcting for mediation by stress awareness the results showed that the program significantly reduced stress symptoms (p =.05) and anxiety (p =.01) at posttest. Effect sizes varied from small to large. Conclusions: Universal prevention programs that address stress and coping in children are warranted given the high prevalence of stress in children and the relationship between stress, on the one hand, and health complaints and pathology, on the other. Such programs are expected to be particularly salient for children with an increased sensitivity to stress and inadequate coping styles (e.g., diathesis-stress model). The results indicate that the school-based program 'Learn Young, Learn Fair' may be a valuable program for reducing stress in children. (copyright) 2009 Association for Child and Adolescent Mental Health.
Journal of Child Psychology & Psychiatry & Allied Disciplines, 50(9) : 1185-1195
- Year: 2009
- Problem: Anxiety Disorders (any)
- Type: Controlled clinical trials
-
Stage: Universal prevention
-
Treatment and intervention: Psychological Interventions (any)
, Other Psychological Interventions
Leong, Joyce, Cobham, Vanessa Elise, deGroot, Jules, McDermott, Brett
Cognitive behavior therapy delivered by trained clinicians has been shown to be an effective treatment for childhood anxiety. However, the prevalence of anxiety disorders in children and adolescents, combined with the practical and psychological obstacles that often prevent families from accessing professional help, mean that alternative ways of reaching prospective clients must be explored. This pilot study aims to compare the relative efficacy of two different modes of delivering a family-focused, cognitive-behavioral intervention for children with an anxiety disorder. The two modalities compared were: a parent-delivered program (bibliotherapy) and a clinician-delivered program (individual therapy). Twenty-seven children aged between 7 and 14, together with their parents, were randomly assigned to one of the two conditions listed above. Results at post-treatment showed a significant improvement for children in both treatment conditions in terms of diagnostic status, number of diagnoses and severity of primary diagnosis at follow-up. Children in the bibliotherapy condition demonstrated a significant improvement over time in terms of child- and parent reported anxiety levels. No differences were found between the two treatment conditions on any outcome measure. These results were maintained at 3- and 6-month follow-up. Although a pilot study, these data suggest that a bibliotherapy format of the intervention described may have potential merit. The implications for service delivery are discussed, as are the limitations of this research. (PsycINFO Database Record (c) 2010 APA, all rights reserved) (journal abstract)
European Child & Adolescent Psychiatry, 18(4) : 231-239
- Year: 2009
- Problem: Anxiety Disorders (any)
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
March, S., Spence, S. H., Donovan, C. L.
OBJECTIVE: To evaluate the efficacy of an Internet-based cognitive-behavioral therapy (CBT) approach to the treatment of child anxiety disorders. METHODS: Seventy-three children with anxiety disorders, aged 7-12 years, and their parents were randomly assigned to either an Internet-based CBT (NET) or wait-list (WL) condition. Clinical diagnostic assessment and parent and child questionnaires were completed before and after treatment. The NET condition was reassessed at 6-month follow-up. RESULTS: At posttreatment assessment, children in the NET condition showed small but significantly greater reductions in anxiety symptoms and increases in functioning than WL participants. These improvements were enhanced during the 6-month follow-up period, with 75% of NET children free of their primary diagnosis. CONCLUSIONS: Internet delivery of CBT for child anxiety offers promise as a way of increasing access to treatment for this population. Future research is needed to examine ways to increase treatment compliance and further enhance the impact of treatment.
Journal of Pediatric Psychology, 34(5) : 474-487
- Year: 2009
- Problem: Anxiety Disorders (any)
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
, Technology, interventions delivered using technology (e.g. online, SMS)
Neil, A. L., Christensen, H.
A systematic review was conducted of school-based prevention and early intervention programs for anxiety. The aim of the review was to identify and describe the programs available, and to evaluate their effectiveness in reducing symptoms of anxiety. Twenty-seven outcome trials, describing 20 individual programs, were identified through the Cochrane Library, PsycInfo and PubMed databases. Results of the review indicated that most universal, selective and indicated prevention programs are effective in reducing symptoms of anxiety in children and adolescents, with effect sizes ranging from 0.11 to 1.37. Most programs targeted adolescents (59%), were aimed at reducing the symptoms of nonspecific anxiety (67%), and delivered cognitive behavioural therapy (CBT; 78%). Further quality school-based research is required that involves longer-term follow-up, the use of attention control conditions and evaluates teacher delivery. (copyright) 2009 Elsevier Ltd. All rights reserved.
Clinical Psychology Review, 29(3) : 208-215
- Year: 2009
- Problem: Anxiety Disorders (any)
- Type: Systematic reviews
-
Stage: Universal prevention
, At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions (any)
Nevo, G. A., Manassis, K.
Background: Anxiety disorders are the most common psychiatric disorders of childhood, generating significant distress in the individual and an economic burden to society. They are precursors to diverse psychiatric illnesses and have an impact on development. Childhood anxiety's reach into the future accentuates the importance of studying the long-term effect of treatment. The purpose of this paper is to examine existing Long-Term-Follow-Up (LTFU) studies' capacity to inform us on the impact of anxiety treatment on development. Method: Medline, PsycInfo, SciSearch, SocScisearch, Cinhal, Embase, and the Cochrane library were searched. Bibliographies of relevant book chapters and review articles and information from colleagues with expertise in anxiety were also a source of information. The search produced more than a thousand citations. Only eight studies met inclusion criteria: follow-up of a cohort of treated anxious youth for more than 2 years. Results: followup ranged from 2 to 7.4 years. The studies were methodologically rigorous and, in general, showed maintenance of or improvement in acute treatment gains. The studies reviewed could not outline course of recovery or control for pivotal confounding variables such as maturation. Seven of the eight studies employed a Cognitive Behavioral intervention and one employed a manualized, time-limited, psychodynamic intervention. No LTFU trial for medication was found. Conclusion: ample evidence exists for the short-term benefit of pediatric anxiety treatment, but evidence is still lacking for the understanding of treatment's role in the facilitation of healthy development into adulthood. Recommendations for future research are proposed. (copyright) 2009 Wiley-Liss, Inc.
Depression & Anxiety, 26(7) : 650-660
- Year: 2009
- Problem: Anxiety Disorders (any)
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions (any)
Suveg, C., Hudson, J. L., Brewer, G., Flannery-Schroeder, E., Gosch, E., Kendall, P. C.
This study examined secondary outcomes of a randomized clinical trial that evaluated an individual cognitive-behavioral (ICBT), family-based cognitive-behavioral (FCBT), and family-based education, support and attention (FESA) treatment for anxious youth. Participants (161) were between 7 and 14 years (M = 10.27) of age and had a principal diagnosis of separation anxiety disorder, social phobia, and/or generalized anxiety disorder. Hierarchical linear modeling examined youth-reported depressive symptomatology and parent- and teacher-reported externalizing behavior and adaptive functioning at pretreatment, posttreatment, and 1-year follow-up. In general, youth in all treatments evidenced improvements in most domains, with improvements maintained at follow-up. Overall, gender and age did not moderate treatment outcomes. The results suggest that both child and family cognitive-behavioral therapy, and the family-based supportive approach used in this study, can be effective in addressing some of the associated symptoms and adaptive functioning deficits typically linked to anxiety in youth. (copyright) 2009 Elsevier Ltd. All rights reserved.
Journal of Anxiety Disorders, 23(3) : 341-349
- Year: 2009
- Problem: Anxiety Disorders (any)
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
Waters, A. M., Ford, L. A., Wharton, T. A., Cobham, V. E.
The present study compared the efficacy of a group-based cognitive-behavioural treatment (GCBT) delivered exclusively to parents of young anxious children (between 4 and 8 years of age) with the same intervention delivered to both children and parents, relative to a Wait-list Control condition. Parents of children in the Parent Only condition (N = 25) received 10 weekly sessions of GCBT whereas children and parents in the Parent + Child condition (N = 24) each received 10 weekly sessions of GCBT. Intent-to-treat analyses indicated that both active treatment conditions were superior to the Wait-list condition (N = 11), with 55.3% of children in the Parent Only condition and 54.8% of children in the Parent + Child condition no longer meeting criteria for their principal diagnosis at post-treatment. These treatment gains were maintained in both treatment conditions at six-month and 12-month follow-up assessments. There were no significant differences between the two active conditions on other outcome measures including parental psychopathology and parenting style. However, an unexpected finding was that parenting satisfaction and to some extent parenting competence reduced significantly from pre- to post-treatment regardless of the active treatment condition. The present results suggest that GCBT delivered exclusively to parents of young anxious children may be a viable treatment alternative for improving accessibility to efficacious treatments for children with anxiety disorders and for reducing costs associated with mental health care delivery. (copyright) 2009 Elsevier Ltd. All rights reserved.
Behaviour Research & Therapy, 47(8) : 654-662
- Year: 2009
- Problem: Anxiety Disorders (any)
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
Wood, J. J., McLeod, B. D., Piacentini, J. C., Sigman, M.
Objective To compare the relative long-term benefit of family-focused cognitive behavioral therapy (FCBT) and child-focused cognitive behavioral therapy (CCBT) for child anxiety disorders at a 1-year follow-up. Method Thirty-five children (6-13 years old) randomly assigned to 12-16 sessions of family-focused CBT (FCBT) or child-focused CBT (CCBT) participated in a 1-year follow-up assessment. Independent evaluators, parents, and children rated anxiety and parental intrusiveness. All were blind to treatment condition and study hypotheses. Results Children assigned to FCBT had lower anxiety scores than children assigned to CCBT on follow-up diagnostician- and parent-report scores, but not child-report scores. Exploratory analyses suggested the advantage of FCBT over CCBT may have been evident more for early adolescents than for younger children and that reductions in parental intrusiveness may have mediated the treatment effect. Conclusion FCBT may yield a stronger treatment effect than CCBT that lasts for at least 1 year, although the lack of consistency across informants necessitates a circumspect view of the findings. The potential moderating and mediating effects considered in this study offer interesting avenues for further study.
Child Psychiatry & Human Development, 40(2) : 301-316
- Year: 2009
- Problem: Anxiety Disorders (any), Generalized Anxiety Disorder, Specific Phobia
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
Salemink, E., VanDenHout, M., Kindt, M.
Over the past 20 years evidence has accumulated that individuals suffering from anxiety tend to interpret ambiguous information as threatening. Considering the causal role of this interpretive bias in anxiety, it was recently established that modifying interpretive biases influences anxiety. This suggests that anxiety can be clinically treated by directly targeting this interpretive bias. The present study was designed to modify a negative interpretive bias in highly anxious individuals, and subsequently assess the hypothesized beneficial effects on clinical measures. High trait-anxious participants were randomly assigned to one of two conditions: a positive interpretational Cognitive Bias Modification (CBM-I) or a control condition (n = 2 null 17). The program was offered online for eight consecutive days. Upon completing the program, participants who had followed positive CBM-I were less state and trait-anxious compared to the control group. Additionally, positively trained participants scored lower on a measure of general psychopathology (SCL-90). No effects were observed on social anxiety and stress vulnerability. The mixed pattern of findings renders them rather inconclusive, leaving interpretations of the potential therapeutic merits of CBM-I open for future research. (copyright) 2009 Elsevier Ltd. All rights reserved.
Journal of Anxiety Disorders, 23(5) : 676-683
- Year: 2009
- Problem: Anxiety Disorders (any)
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions (any)
, Attention/cognitive bias modification
Sheehan, David V., Kamijima, Kunitoshi
Sertraline is a selective serotonin reuptake inhibitor that has been used and studied extensively throughout the world and found to be safe and well tolerated in numerous patient populations, including those with either psychiatric and/or medical comorbidities. Randomized clinical trials have shown that it is an effective treatment for depressive and anxiety disorders and its efficacy is unaffected by psychiatric comorbidity. In non-comorbid patients, sertraline is effective for the acute treatment of major depressive disorders and prevention of relapse or recurrence. It is effective for acute treatment and longer-term management of social anxiety disorder, posttraumatic stress disorder,panic disorder, and generalized anxiety disorder. In adults and in pediatric patients, it is an effective short-term and long-term treatment for obsessive compulsive disorder.Sertraline has a good tolerability profile and has low fatal toxicity. In summary, sertraline is as effective as other antidepressants over a wide range of indications but may offer tolerability benefits as well as efficacy in patients with psychiatric and/or medical comorbidities and certain subtypes of depression.
International Clinical Psychopharmacology, 24(2) : 43-60
- Year: 2009
- Problem: Anxiety Disorders (any), Obsessive Compulsive Disorder
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Selective serotonin reuptake inhibitors (SSRIs)
Smits, J. A. J., Berry, A. C., Rosenfield, D., Powers, M. B., Behar, E., Otto, M. W.
Background: Exercise interventions repeatedly have been shown to be efficacious for the treatment of depression, and initial studies indicate similar efficacy for the treatment of anxiety conditions. To further study the potential beneficial role of prescriptive exercise for anxiety-related conditions, we examined the role of exercise in reducing fears of anxiety-related sensations (anxiety sensitivity). Methods: We randomly assigned 60 participants with elevated levels of anxiety sensitivity to a 2-week exercise intervention, a 2-week exercise plus cognitive restructuring intervention, or a waitlist control condition. Assessment of outcome was completed at pretreatment, midtreatment, 1-week posttreatment, and 3-week follow-up. Results: We found that both exercise conditions led to clinically significant changes in anxiety sensitivity that were superior to the waitlist condition, representing a forge controlled effect size (d = 2.15). Adding a cognitive component did not facilitate the effects of the exercise intervention. Consistent with hypotheses, changes in anxiety sensitivity mediated the beneficial effects of exercise on anxious and depressed mood. Conclusions: We discuss these findings in terms of the potential role of exercise as an additional psychosocial intervention for conditions such as panic disorder, where anxiety sensitivity is a prominent component of pathology. copyright 2008 Wiley-Liss, Inc.
Depression & Anxiety, 25(8) : 689-699
- Year: 2008
- Problem: Anxiety Disorders (any)
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Complementary & Alternative Interventions (CAM)
, Psychological Interventions (any)
, Other Psychological Interventions, Physical activity, exercise