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Treatment of child anxiety disorders via guided parent-delivered cognitive–behavioural therapy: Randomised controlled trial

  • Kerstin Thirlwall (a1), Peter J. Cooper (a2), Jessica Karalus (a1), Merryn Voysey (a3), Lucy Willetts (a1) and Cathy Creswell (a1)...
Abstract
Background

Promising evidence has emerged of clinical gains using guided self-help cognitive–behavioural therapy (CBT) for child anxiety and by involving parents in treatment; however, the efficacy of guided parent-delivered CBT has not been systematically evaluated in UK primary and secondary settings.

Aims

To evaluate the efficacy of low-intensity guided parent-delivered CBT treatments for children with anxiety disorders.

Method

A total of 194 children presenting with a current anxiety disorder, whose primary carer did not meet criteria for a current anxiety disorder, were randomly allocated to full guided parent-delivered CBT (four face-to-face and four telephone sessions) or brief guided parent-delivered CBT (two face-to-face and two telephone sessions), or a wait-list control group (trial registration: ISRCTN92977593). Presence and severity of child primary anxiety disorder (Anxiety Disorders Interview Schedule for DSM-IV, child/parent versions), improvement in child presentation of anxiety (Clinical Global Impression –Improvement scale), and change in child anxiety symptoms (Spence Children's Anxiety Scale, child/parent version and Child Anxiety Impact scale, parent version) were assessed at post-treatment and for those in the two active treatment groups, 6 months post-treatment.

Results

Full guided parent-delivered CBT produced superior diagnostic outcomes compared with wait-list at post-treatment, whereas brief guided parent-delivered CBT did not: at post-treatment, 25 (50%) of those in the full guided CBT group had recovered from their primary diagnosis, compared with 16 (25%) of those on the wait-list (relative risk (RR) 1.85, 95% CI 1.14–2.99); and in the brief guided CBT group, 18 participants (39%) had recovered from their primary diagnosis post-treatment (RR = 1.56, 95% CI 0.89–2.74). Level of therapist training and experience was unrelated to child outcome.

Conclusions

Full guided parent-delivered CBT is an effective and inexpensive first-line treatment for child anxiety.

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Copyright
Royal College of Psychiatrists, This paper accords with the Wellcome Trust Open Access policy and is governed by the licence available at http://www.rcpsych.ac.uk/pdf/Wellcome%20Trust%20licence.pdf
Corresponding author
Kerstin Thirlwall, Winnicott Research Unit, School of Psychology and Clinical Language Sciences, University of Reading, Berkshire RG6 6AL, UK. Email: k.j.thirlwall@reading.ac.uk
Footnotes
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See editorial, pp. 401–402, this issue.

Declaration of interest

C.C. and L.W. receive royalties as authors of the self-help book used for guided parent-delivered CBT.

Footnotes
References
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Treatment of child anxiety disorders via guided parent-delivered cognitive–behavioural therapy: Randomised controlled trial

  • Kerstin Thirlwall (a1), Peter J. Cooper (a2), Jessica Karalus (a1), Merryn Voysey (a3), Lucy Willetts (a1) and Cathy Creswell (a1)...
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