Effectiveness of cognitive behavioral therapy (CBT) for child and adolescent anxiety disorders across different CBT modalities and comparisons: a systematic review and meta-analysis

Abstract

Aim: Pediatric Anxiety Disorders (AD) are common. Cognitive behavioral therapy (CBT) is one of two first-line treatments of youth AD and it has previously been shown to be superior to wait-list but not placebo therapy. This study consists of a systematic review and meta-analysis of the literature to assess the efficacy of CBT modalities in comparison to control contingencies for pediatric anxiety disorders.

Methods: Studies were included if they were randomized controlled trials, and if CBT was manualized or modular, alone or in combination with medication. CBT was required to include behavioral treatment, exposure treatment, or cognitive elements. Eligible studies included participants aged 18 years or younger.

Results: Eighty-one studies were included, with 3386 CBT participants and 2527 control participants. The overall results indicated that CBT is an effective treatment for childhood AD. The results showed that individual-based CBT is superior to wait-list and attention control. Group-based CBT is superior to wait-list control and treatment as usual. Remote-based CBT was superior to attention control and wait-list control. Family-based CBT was superior to treatment as usual, wait-list control, and attention control. Selective serotonin reuptake inhibitors were no more effective than individual-based CBT. Combination treatment was, however, more effective than individual-based CBT.

Conclusion: To the best of our knowledge, no meta-analysis has thus far disentangled the effects of CBT modalities across various comparisons. This meta-analysis hence provides an important update to the literature on the efficacy of CBT for treating anxiety disorders in young people.

Keywords:

• CBT
• anxiety
• childhood
• meta-analysis
• systematic review

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Notes on contributors

Anna Lilja Sigurvinsdóttir

Anna Lilja Sigurvinsdóttir, MS, is a psychologist, The Health Care Institution of North, Akureyri, Iceland.

Kolbrún Björk Jensínudóttir

Kolbrún Björk Jensínudóttir, BSc, is a postgraduate student in psychology, University of Iceland, Reykjavik, Iceland.

Karen Dögg Baldvinsdóttir

Karen Dögg Baldvinsdóttir, BSc. psych and Orri Smárason, C., is a psychologist, National University Hospital of Iceland, Reykjavik, Iceland.

Orri Smárason

Karen Dögg Baldvinsdóttir, BSc. psych and Orri Smárason, C., is a psychologist, National University Hospital of Iceland, Reykjavik, Iceland.

Gudmundur Skarphedinsson

Gudmundur Skarphedinsson, PhD, is a psychologist and an associate professor, Faculty of Psychology, University of Iceland, Reykjavik, Iceland.