Friday, November 2, 2018

Meta-Analysis Finds Group CBT Optimal Psychotherapy for Children, Adolescents With Anxiety

Group therapy may work best for children and adolescents with anxiety, a meta-analysis of various psychotherapies found, with group cognitive-behavioral therapy (CBT) showing the greatest effectiveness in reducing anxiety symptoms. The report was published this week in JAMA Psychiatry.

“The results of our analysis suggest that psychotherapy delivered in a group format may generally result in better outcomes than when delivered individually,” wrote Xinyu Zhou, Ph.D., of Chongqing Medical University in China and colleagues. The benefit “may be attributed to the additional exposure of social stimuli and interaction in the group format and thus increasing the efficacy of psychotherapy.”

Zhou and colleagues searched various databases for studies that compared any structured psychotherapy with another (or a control condition) for the acute treatment of anxiety disorders in children and adolescents (18 years or younger). The meta-analysis included 6,625 participants who received one of 11 distinct psychotherapies.

Most (93) of the 101 trials included in the meta-analysis assessed various forms of CBT (individual and/or group CBT, CBT with parental involvement, parent-only CBT, and self-help forms of CBT). Eight studies assessed forms of behavioral therapy (BT), including individual and/or group BT or individual BT with parental involvement.

The authors examined the efficacy of the various psychotherapies, as measured by the change in anxiety symptoms from baseline to the end of therapy and from baseline to the end of follow-up (≤12 months). The authors also examined post-therapy changes in quality of life and functional improvement and the acceptability of the therapies, defined as the proportion of patients who discontinued for any reason during the acute phase of treatment.

The meta-analysis revealed that most psychotherapies were significantly more effective than the wait-list condition posttreatment and at follow-up. However, only group CBT was found to be significantly more effective than other psychotherapies posttreatment and at short-term follow-up. In terms of quality of life and functional improvement, CBT delivered in various ways was significantly beneficial, compared with psychological placebo and the wait-list condition.

The authors found that self-help CBT, such as internet-assisted CBT and bibliotherapy CBT, could be useful clinical tools, since they were more effective at reducing anxiety symptoms than wait-list conditions. However, participants receiving bibliotherapy were 2.5 times to more than 9 times more likely to discontinue treatment, compared with other psychotherapies and control conditions.

“This network meta-analysis suggests that group CBT might be considered as the initial choice of psychotherapy for anxiety disorders in children and adolescents; however, more research is needed to confirm such conclusions,” the researchers wrote.

For related information, see the Psychiatric News article “Childhood Anxiety Can Be Treated—the Challenge is to Recognize It.”

(Image: iStock/asiseeit)


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