Evidence-Based Psychosocial Treatments for Phobic and Anxiety Disorders in Children and Adolescents

Abstract

The article reviews psychosocial treatments for phobic and anxiety disorders in youth. Using criteria from Nathan and Gorman (2002), 32 studies are evaluated along a continuum of methodological rigor. In addition, the treatments evaluated in each of the 32 studies are classified according to Chambless et al.'s (1996) and Chambless and Hollon's (1998) criteria. Findings from a series of meta-analyses of the studies that used waitlists also are reported. In accordance with Nathan and Gorman, the majority of the studies were either methodologically robust or fairly rigorous. In accordance with Chambless and colleagues, although no treatment was well-established, Individual Cognitive Behavior Therapy, Group Cognitive Behavior Therapy (GCBT), GCBT with Parents, GCBT for social phobia (SOP), and Social Effectiveness Training for children with SOP each met criteria for probably efficacious. The other treatments were either possibly efficacious or experimental. Meta-analytic results revealed no significant differences between individual and group treatments on diagnostic recovery rates and anxiety symptom reductions, as well as other youth symptoms (i.e., fear, depression, internalizing and externalizing problems). Parental involvement was similarly efficacious as parental noninvolvement in individual and group treatment formats. The article also provides a summary of the studies that have investigated mediators, moderators, and predictors of treatment outcome. The article concludes with a discussion of the clinical representativeness and generalizability of treatments, practice guidelines, and future research directions.

Support for the writing of this article comes from NIMH RO1 # 63997 awarded to Wendy K. Silverman.

Notes

Note: A dash indicates that this was not reported in the article. N is the number of youth who met the study's inclusion criteria for participation. Nc is the number of youth who completed the intervention. % success is based on number of completers no longer meeting DSM criteria for the primary/treated anxiety disorder diagnosis at posttreatment.

^a 73% in Individual Cognitive Behavior Therapy; 50% in Group Cognitive Behavior Therapy.

^b Based on parent-reported interview data, 53%; based on youth interview data, 45.74% (some youth did not meet criteria for an anxiety disorder diagnoses at pretreatment).

^c 92% in bibliotherapy + telephone; 75% in bibliotherapy + email, 47% in bibliotherapy + client-initiate.

^d 61.1% in GCBT, 25.9% in Bibliotherapy.

^e Based on parent-reported interview data, 66.7% in GCBT with parent, 60.9% in GCBT with parent plus Internet.

Note: Adapted from Division 12 Task Force on Psychological Interventions' reports (Chambless et al., 1998; Chambless et al., 1996) and from Chambless and Hollon (1998), who also describe criteria for methodology.

Notes: ICBT = Individual Cognitive Behavior Therapy; GCBT = Group Cognitive Behavior Therapy; SOP = social phobia; SP = simple/specific phobia; EMDR = eye movement desensitization and reprocessing.

Note: K = the number of independent samples that contributed an effect size; N = total sample size across the K samples; p-hat = the average proportion of participants who improved because of treatment (the sample size weighted average); P-hat = was computed as ∑n_ip_i/∑n_i where the summation is over the K samples and p_i and n_i are the proportions of participants who no longer meet diagnostic criteria for the treated anxiety disorder diagnosis at posttreatment and the sample size, respectively, in each individual sample. CBT = Cognitive Behavior Therapy; ICBT = Individual Cognitive Behavior Therapy; GCBT = Group Cognitive Behavior Therapy.

¹Fail-safe-N is the number of samples with an average effect size of zero that should have been left out in our meta-analyses to lower the estimated effect size to .10 (the Fail-safe-N was computed as k[(d/dc) − 1] where k is the number of effect sizes in that meta-analysis, d is the computed average effect size, dc is the critical value which was taken as .10 here); Qw is the variability among effect sizes and significant values suggest the presence of moderators (Qw was computed as k*Obs variance/sampling error variance and is a chi-square with k − 1 degrees of freedom).

Note: K = the number of independent samples that contributed an effect size; N = total sample size across the K samples; Other Symptoms = fear and depression; CBT = Cognitive Behavior Therapy; ICBT = Individual Cognitive Behavior Therapy; GCBT = Group Cognitive Behavior Therapy.

Note: No data were available to derive anxiety effect sizes and corresponding statistical indexes for Individual Cognitive Behavior Therapy (ICBT), Group Cognitive Behavior Therapy (GCBT), ICBT with Parents, or GCBT with Parents. Other Symptoms = fear, depression and internalizing and externalizing child behavior problems; CBT = Cognitive Behavior Therapy.

∗References marked with an asterisk indicate studies included in the meta-analysis.