A randomized controlled trial of a bidirectional cultural adaptation of cognitive behavior therapy for children and adolescents with anxiety disorders

Abstract

Background: Cognitive behavior therapy (CBT) programs with ethnic and cultural sensitivity are scarce. This study was the first randomized controlled trial of cognitive behavior therapy for children and adolescents with anxiety disorders using bidirectional cultural adaptation.

Methods: The Japanese Anxiety Children/Adolescents Cognitive Behavior Therapy program (JACA-CBT) was developed based on existing evidence-based CBT for anxious youth and optimized through feedback from clinicians in the indigenous cultural group. Fifty-one children and adolescents aged 8-15 with anxiety disorders were randomly allocated to either a cognitive behavioral treatment (CBT: 122.08 days, SD = 48.15) or a wait-list control condition (WLC: 70.00 days, SD = 11.01). Participants were assessed at pre-treatment and post-treatment as well as 3 and 6 months after completion of treatment (92.88 days, SD = 17.72 and 189.42 days, SD = 25.06) using a diagnostic interview, self-report measures of anxiety, depression, cognitive errors, and a parent-report measure of anxiety.

Results: A significant difference was found between the CBT and WLC at post-treatment, specifically 50% of participants in the treatment condition were free from their principal diagnoses compared to 12% in the wait-list condition, χ² (1, N = 51) = 8.55, η² = 0.17, p < .01. In addition, participants in the treatment condition showed significant improvement in clinical severity and child-self reported depression, F (1, 49) = 12.38, p < .001, F (1, 47.60) = 5.95, p < .05. At post-treatment, Hedge's g between the conditions was large for clinical severity, 1.00 (95% CI = 0.42-1.58), and moderate for the self-report anxiety scale, 0.43 (0.19-1.04), two depression scales, 0.39 (0.22-1.00), 0.48 (0.14-1.09), and the cognitive errors scale, 0.38 (0.24-0.99). Finally, significant improvements in diagnostic status were evident at the 3 and 6-month follow-up assessments when combining the CBT and WLC, ps < .001.

Conclusion: The current results support the transportability of CBT and the efficacy of a bidirectional, culturally adapted cognitive behavior therapy in an underrepresented population.

Keywords: Anxiety; Child; Cognitive behavior therapy; Cultural adaptation.