A Randomized Clinical Trial Comparing Individual Cognitive Behavioral Therapy and Child-Centered Therapy for Child Anxiety Disorders

Abstract

This study compared individual cognitive behavioral therapy (CBT) and a supportive child-centered therapy (CCT) for child anxiety disorders on rates of treatment response and recovery at posttreatment and 1-year follow-up, as well as on real-world measures of emotional functioning. Youth (N = 133; ages 9-14) with anxiety disorders (generalized, separation, and/or social anxiety) were randomized using a 2:1 ratio to CBT (n = 90) or CCT (n = 43), which served as an active comparison. Treatment response and recovery at posttreatment and 1-year follow-up were assessed by Independent Evaluators, and youth completed ecological momentary assessment of daily emotions throughout treatment. The majority of youth in both CBT and CCT were classified as treatment responders (71.1% for CBT, 55.8% for CCT), but youth treated with CBT were significantly more likely to fully recover, no longer meeting diagnostic criteria for any of the targeted anxiety disorders and no longer showing residual symptoms (66.7% for CBT vs. 46.5% for CCT). Youth treated with CBT also reported significantly lower negative emotions associated with recent negative events experienced in daily life during the latter stages of treatment relative to youth treated with CCT. Furthermore, a significantly higher percentage of youth treated with CBT compared to CCT were in recovery at 1-year follow-up (82.2% for CBT vs. 65.1% for CCT). These findings indicate potential benefits of CBT above and beyond supportive therapy on the breadth, generalizability, and durability of treatment-related gains.

Trial registration: ClinicalTrials.gov NCT00774150.

Figure 1. Consort Diagram

¹Two participants were originally erroneously randomized to treatment, but did not meet inclusion/exclusion criteria for the study. These participants are included above as “ineligible”; *Subjects who withdrew from treatment continued to do follow-up assessments. **Subjects who withdrew from treatment and assessments did not do any follow-up assessments

Figure 2

Peak Negative Affect Ratings across Time, by Treatment Condition. Post-hoc contrast tests indicate that youth in cognitive behavioral therapy (CBT) reported lower levels of peak negative affect relative to youth in child-centered therapy (CCT) following Session 8, specifically, across the sampling weeks that occurred after the introduction of exposure in CBT (Session 12 and Post-treatment), t(1697.307) = 4.44, p < .001; Cohen’s d = .19. No group differences were observed in ratings of peak negative affect before the introduction of exposure in CBT (Baseline, Session 4, and Session 8), t(136.238) = .082, p = .935, Cohen’s d = .02. Error bars represent the standard error group differences in Peak negative affect at each time point.