Eight years later: outcomes of CBT-treated versus untreated anxious children.

BACKGROUND: Anxiety disorders are the most common psychiatric disorders of childhood, generate significant distress, are considered precursors to diverse psychiatric disorders, and lead to poor social and employment outcomes in adulthood. Although childhood anxiety has a significant impact on a child's developmental trajectory, only a handful of studies examined the long-term impact of treatment and none included a control group. The aim of this study was to conduct a long-term follow-up (LTFU) of anxious children who were treated with Cognitive-Behavioral Therapy (CBT) compared to a matched group of children who were not. METHODS: Subjects comprised 120 children: a treatment group which included the first 60 consecutive consenting children who were diagnosed with an anxiety disorder and treated with CBT between the years 1997 and 2003 and a control group, 60 matched children who were assessed but not treated with CBT. An "ex-post-facto" design was used to compare the two groups. RESULTS: Children showed lower rates of anxiety diagnosis (about 50% for both groups) and significantly improved functioning at LTFU (time effect P < 0.0001; no group difference). Anxiety levels were significantly lower in the nontreatment group at LTFU as compared to initial assessment (P = 0.02), but not in the treatment group, and a significant between-group difference was found (P = 0.01) according to child. An inverse relationship was found between self-efficacy/self-esteem and anxiety outcome ([P = 0.0008] and [P = 0.04], respectively). CONCLUSIONS: This study supports the assumption that childhood anxiety disorders may improve without treatment and highlights self-efficacy/self-esteem as potential factors in recovery.

Mind over PMDD: A Glimpse into the Process of Pharmacotherapy-Psychotherapy Combination Treatment.

The practice of combining pharmacotherapy with psychotherapy is advocated for as treatment of choice for many psychiatric disorders. Despite an abundance of outcome studies addressing this subject, little has been written about the process of combined treatment, leaving clinicians with insufficient guidance as to the "how" of the medication-psychotherapy merger. This case report follows the treatment course of a fourteen-year-old young woman initially diagnosed with Premenstrual Dysphoric Disorder (PMDD) and provisional Generalized Anxiety Disorder (GAD). It demonstrates the benefits, drawbacks, possible pitfalls and successful outcome of combined therapy, an outcome which may not have been achieved had only one of the modalities been used.

La pratique de combiner pharmacothérapie et psychothérapie est revendiquée comme traitement de choix de nombreux troubles psychiatriques. Malgré une abondance d'études sur les résultats traitant de ce sujet, peu de choses ont été écrites sur le processus du traitement combiné, laissant les cliniciens sans directives suffisantes sur le « comment ¼ de la fusion médication-psychothérapie. Cette étude de cas suit le cours du traitement d'une jeune femme de 14 ans ayant reçu un diagnostic initial de trouble dysphorique prémenstruel (TDPM) et de trouble d'anxiété généralisée (TAG) provisoire. L'étude démontre les avantages, les inconvénients, les pièges possibles et le résultat réussi de la thérapie combinée, résultat qui n'aurait peut-être pas été atteint si une seule des modalités avait été utilisée.

An adaptation of prolonged exposure therapy for pediatric single incident trauma: a case series.

OBJECTIVE: To assess the efficacy of a modification for Prolonged Exposure (PE) therapy for single incident trauma in youth and examine the effective component(s) of treatment. METHOD: Fifteen youth (2 boys, 13 girls; mean age= 10.8 years) were treated with a developmentally modified version of PE called Trauma Mastery Therapy (TMT). The youth were evaluated pre-treatment, every 2 treatment sessions, and at 1 month follow-up. PRIMARY OUTCOME MEASURE: the Child PTSD Symptom Scale (CPSS), a self administered PTSD questionnaire. RESULTS: Post-treatment, 13 participants did not meet criteria for PTSD. Patients showed significant improvement at post-treatment. Analysis of variance models with pair-wise contrasts showed significantly higher scores at initiation of treatment as compared to the end of the exposure phase and, to a lesser extent, as compared to the psychoeducational phase, but no further significant improvement following the relapse prevention or follow-up phases. CONCLUSIONS: TMT appears to be a promising treatment for single incident trauma in youth. Flexibility within the structure of TMT may facilitate treatment success. The study suggests exposure, and to some extent, psychoeducation, to be important components of treatment. Additional research is required to further validate these initial findings.

An innovative child CBT training model for community mental health practitioners in Ontario.

OBJECTIVE: Cognitive behavior therapy (CBT) for children has been shown efficacious, but community access to it is often limited by the lack of trained therapists. This study evaluated a child, CBT-focused, 20-session weekly group supervision seminar with a didactic component which was provided to community mental health practitioners by experienced CBT therapists from an academic center. METHODS: Twenty-two practitioners from four community mental health agencies completed the training in four groups (one for each agency); one group was trained by videoconference. The authors assessed outcomes immediately after the training and at 6-month follow-up using a mixed-method design including quantitative and qualitative methods to ensure a comprehensive evaluation. RESULTS: Participants' knowledge on a multiple-choice test of child CBT increased with training, as did their self-reported confidence using CBT and desire to do further child CBT. Therapist age and use of an intake diagnostic screen related to positive outcomes, and participants advocated for more structured training. CONCLUSION: Child CBT can be successfully taught to community practitioners using this training model, but refinement based on participant feedback and further studies that include direct observation of CBT skills are needed.

Mood assessment via animated characters: a novel instrument to evaluate feelings in young children with anxiety disorders.

We evaluated a novel, computerized feelings assessment instrument (MAAC) in 54 children with anxiety disorders and 35 nonanxious children ages 5 to 11. They rated their feelings relative to 16 feeling animations. Ratings of feelings, order of feeling selection, and correlations with standardized anxiety measures were examined. Positive emotions were rated more highly and visited earlier by nonanxious children. Children with anxiety disorders explored fewer emotions. MAAC ratings on several positive emotions showed inverse correlations with state anxiety. Although needing further evaluation, MAAC may facilitate feelings assessment in young children and may distinguish children with anxiety disorders from nonanxious children.

Psychosocial treatment of pediatric posttraumatic stress disorder: the neglected field of single-incident trauma.

Despite the prevalence of childhood trauma, studies regarding psychotherapy for children suffering from posttraumatic stress disorder (PTSD) are scarce, especially regarding the treatment for pediatric PTSD following single-incident trauma. Treatment practices for this population rely mainly on the paradigms of therapy for adult PTSD and pediatric PTSD following sexual abuse. This review outlines the studies published in the last 10 years pertaining to the treatment of pediatric PTSD following single-incident trauma. This is done in the context of available literature on the paradigms mentioned above. Of 742 articles dealing with treatment of pediatric trauma, 10 were found relevant to the treatment of pediatric PTSD following single-incident trauma. The modalities of treatment most frequently reported in this context were cognitive-behavioral therapy (CBT), eye movement desensitization and reprocessing (EMDR), and play therapy. As a whole, CBT studies were methodologically more rigorous, used manualized, reproducible treatment, and were group, school-based therapies. EMDR treatments were usually short and individual. Most studies showed statistically significant improvement but were still methodologically lacking. We conclude that research on the subject of treatment for pediatric PTSD following single-incident trauma constitutes a neglected part of the study of pediatric PTSD. This stands in contrast to the obvious prevalence of this type of trauma. We encourage future research that will address issues such as clarifying the role of pharmacotherapy, comparing different modes of treatment, dismantling treatment "packages," researching developmentally sensitive treatments, conducting long-term follow-up, and comparing different PTSD populations.