Cognitive-behavioral therapy for youth anxiety: An effectiveness evaluation in community practice

Abstract

Objective: To compare the effectiveness of individual cognitive–behavioral therapy (ICBT) and group CBT (GCBT) for referred children with anxiety disorders within community mental health clinics. Method: Children (N = 165; ages 7–13 years) referred to 5 clinics in Norway because of primary separation anxiety disorder (SAD), social anxiety disorder (SOC), or generalized anxiety disorder (GAD) based on Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.) criteria participated in a randomized clinical trial. Participants were randomized to ICBT, GCBT, or wait list (WL). WL participants were randomized to 1 of the 2 active treatment conditions following the wait period. Primary outcome was loss of principal anxiety disorder over 12 weeks and 2-year follow-up. Results: Both ICBT and GCBT were superior to WL on all outcomes. In the intent-to-treat analysis, 52% in ICBT, 65% in GCBT, and 14% in WL were treatment responders. Planned pairwise comparisons found no significant differences between ICBT and GCBT. GCBT was superior to ICBT for children diagnosed with SOC. Improvement continued during 2-year follow-up with no significant between-groups differences. Conclusions: Among anxiety disordered children, both individual and group CBT can be effectively delivered in community clinics. Response rates were similar to those reported in efficacy trials. Although GCBT was more effective than ICBT for children with SOC following treatment, both treatments were comparable at 2-year follow-up. Dropout rates were lower in GCBT than in ICBT, suggesting that GCBT may be better tolerated. Response rates continued to improve over the follow-up period, with low rates of relapse. What is the public health significance of this article?

Findings indicate that both individual and group cognitive–behavioral therapy can be effectively delivered by community mental health practitioners with only a minimal amount of formal training. Outcomes were similar to those reported in more controlled settings.