This article is more than 5 years old. Information may no longer be current.

Group CBT reduces anxiety symptoms in pediatric patients

Group cognitive behavioral therapy was significantly more effective in reducing anxiety symptoms in children and adolescents compared with other psychotherapies, according to data published in JAMA Psychiatry.

“Psychological treatments, especially cognitive behavioral therapy, are commonly used to treat anxiety disorders in children and adolescents,” Xinyu Zhou, PhD, from department of psychiatry at The First Affiliated Hospital of Chongqing Medical University in China, and colleagues wrote. “However, other psychotherapies are also in use, such as [behavioral therapy] without the cognitive restructuring component and bibliotherapy.”

To determine the optimal strategy of psychotherapies in children and teens with anxiety disorders, researchers compared and ranked the different types of psychotherapies and the different ways of delivering these treatments using data from electronic clinical databases.

The investigators included data from randomized clinical trials comparing any structured psychotherapy with another psychotherapy or a control condition for anxiety disorders in pediatric patients, then performed pairwise meta-analyses and Bayesian network meta-analysis within the random-effects model to synthesize data. They measured participants’ efficacy post-treatment and at follow-up, acceptability and quality of life and functional improvement.

The analysis included 101 unique trials that encompassed 6,625 unique participants comparing 11 different psychotherapies with four specific control conditions. For the study quality, most trials were rated at moderate risk of bias, about 20% were considered high risk of bias and nearly 8% were considered low-risk.

Network meta-analysis assessing efficacy revealed that most psychotherapies were significantly more effective than the wait list condition post-treatment (standardized mean difference [SMD] = –1.43 to –0.61) and at the longest follow-up (SMD = –1.84 to –1.64). Only group CBT was significantly more effective than other psychotherapies and control conditions at short-term follow-up (SMD range = –0.43 to –0.82).

In terms of acceptability, Zhou and colleagues found that only bibliotherapy CBT had significantly more all-cause discontinuations than some other psychotherapies and

control conditions (range of ORs = 2.48- 9.32). For quality of life/functioning, almost all CBT — excluding behavioral therapy — demonstrated significantly more benefit over psychological placebo and the wait list condition (SMD range = 0.73-1.99), according to the results.

“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,” Zhou and colleagues wrote. “Health care professionals, patients and families should carefully interpret these findings, bearing in mind the limited amount of information and the low-quality of available evidence.” – by Savannah Demko

Disclosure: Zhou reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.