Skip to main content
SpringerLink
Log in

A Meta-analysis to Guide the Enhancement of CBT for Childhood Anxiety: Exposure Over Anxiety Management

  • Published:
Clinical Child and Family Psychology Review Aims and scope Submit manuscript

Abstract

Cognitive behavior therapy (CBT) is the most empirically supported therapy for childhood anxiety disorders (CADs) but has not reliably outperformed other credible interventions. The current study used meta-analysis to examine the frequency with which the most common treatment components are included in outcome studies and the relation of these components to symptom improvement. Seventy-five studies were identified that included youth with an anxiety disorder treated with CBT or a comparison condition. The protocols for the 111 CBT conditions generally consisted of 12, 1-h sessions delivered to the child with minimal parent inclusion. A greater amount of in-session exposure was related to significantly larger effect sizes between CBT and waitlist control across reporters (− 0.12 to − 0.15; P’s < .05) and from pre- to post-treatment for child report (− .06; P < .01). Compared to treatments that omitted relaxation, treatments that included relaxation strategies were associated with significantly smaller pre- to post-treatment effect sizes across reporters (0.38 to 0.80; P’s < .05). The current study suggests that CBT protocols for CADs that emphasize in-session exposure and do not include relaxation have the potential to improve the efficacy and effectiveness of therapy. Dismantling studies directly testing these hypotheses are needed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  • Abbasi, Z., Amiri, S., & Talebi, H. (2016). The effective comparison between modular cognitive behavioral therapy (MCBT) and child-parent relationship training (CPRT) in children with separation anxiety symptoms. Social Sciences (Pakistan),11(6), 890–902. https://doi.org/10.3923/sscience.2016.890.902.

    Article  Google Scholar 

  • Abramowitz, J. S., Whiteside, S. P., & Deacon, B. J. (2005). The effectiveness of treatment for pediatric obsessive-compulsive disorder: A meta-analysis. Behavior Therapy,36, 55–63.

    Article  Google Scholar 

  • Afshari, A., Neshat-Doost, H. T., Maracy, M. R., Ahmady, M. K., & Amiri, S. (2014). The effective comparison between emotion-focused cognitive behavioral group therapy and cognitive behavioral group therapy in children with separation anxiety disorder. Journal of Research in Medical Sciences,19(3), 221–227.

    PubMed  PubMed Central  Google Scholar 

  • Ale, C. M., McCarthy, D. M., Rothschild, L., & Whiteside, S. (2015). Components of cognitive behavioral therapy related to outcome in childhood anxiety disorders. Clinical Child and Family Psychology Review,18, 240–251. https://doi.org/10.1007/s10567-015-0184-8.

    Article  PubMed  Google Scholar 

  • Amoros-Boix, M., Rosa-Alcazar, A. I., & Olivares-Olivares, P. J. (2011). Role of the focus of attention in the treatment of generalized social phobia in adolescents. Anales De Psicologia,27(3), 718–728.

    Google Scholar 

  • Arendt, K., Thastum, M., & Hougaard, E. (2016). Efficacy of a Danish version of the Cool Kids program: A randomized wait-list controlled trial. Acta Psychiatrica Scandinavica,133(2), 109–121. https://doi.org/10.1111/acps.12448.

    Article  PubMed  Google Scholar 

  • Baer, S., & Garland, E. J. (2005). Pilot study of community-based cognitive behavioral group therapy for adolescents with social phobia. Journal of the American Academy of Child and Adolescent Psychiatry,44(3), 258–264. https://doi.org/10.1097/00004583-200503000-00010.

    Article  PubMed  Google Scholar 

  • Barrett, P. M. (1998). Evaluation of cognitive-behavioral group treatments for childhood anxiety disorders. Journal of Clinical Child Psychology,27(4), 459–468. https://doi.org/10.1207/s15374424jccp2704_10.

    Article  PubMed  Google Scholar 

  • Barrett, P. M., Dadds, M. R., & Rapee, R. M. (1996). Family treatment of childhood anxiety: A controlled trial. Journal of Consulting and Clinical Psychology,64(2), 333–342. https://doi.org/10.1037//0022-006X.64.2.333.

    Article  PubMed  Google Scholar 

  • Barrington, J. W., Prior, M., Richardson, M., & Allen, K. (2005). Effectiveness of CBT versus standard treatment for childhood anxiety disorders in a community clinic setting. Behavior Change,22, 29–43.

    Article  Google Scholar 

  • Becker-Haimes, E. M., Okamura, K. H., Wolk, C. B., Rubin, R., Evans, A. C., & Beidas, R. S. (2017). Predictors of clinician use of exposure therapy in community mental health settings. Journal of Anxiety Disorders,49, 88–94. https://doi.org/10.1016/j.janxdis.2017.04.002.

    Article  PubMed  PubMed Central  Google Scholar 

  • Beidas, R. S., & Kendall, P. C. (2010). Training therapists in evidence-based practice: A critical review of studies from a systems-contextual perspective. Clinical Psychology: Science and Practice (New York),17(1), 1–30. https://doi.org/10.1111/j.1468-2850.2009.01187.x.

    Article  Google Scholar 

  • Beidas, R. S., Mychailyszyn, M. P., Podell, J. L., & Kendall, P. C. (2013). Brief cognitive-behavioral therapy for anxious youth: The inner workings. Cognitive and Behavioral Practice,20(2), 134–146. https://doi.org/10.1016/j.cbpra.2012.07.004.

    Article  PubMed  Google Scholar 

  • Beidel, D. C., Turner, S. M., & Morris, T. L. (2000). Behavioral treatment of childhood social phobia. Journal of Consulting and Clinical Psychology,68(6), 1072–1080. https://doi.org/10.1037//0022-006X.68.6.1072.

    Article  PubMed  Google Scholar 

  • Beidel, D. C., Turner, S. M., Sallee, F. R., Ammerman, R. T., Crosby, L. A., & Pathak, S. (2007). SET-C versus fluoxetine in the treatment of childhood social phobia. Journal of the American Academy of Child and Adolescent Psychiatry,46(12), 1622–1632. https://doi.org/10.1097/chi.0b013e318154bb5718030084.

    Article  PubMed  Google Scholar 

  • Benito, K. G., Machan, J., Freeman, J. B., Garcia, A. M., Walther, M., Frank, H., …, Franklin, M. (2018). Measuring fear change within exposures: Functionally-defined habituation predicts outcome in three randomized controlled trials for pediatric OCD. Journal of Consulting and Clinical Psychology, 86(7), 615–630. https://doi.org/10.1037/ccp0000315.

    Article  PubMed  PubMed Central  Google Scholar 

  • Chavira, D. A., Drahota, A., Garland, A. F., Roesch, S., Garcia, M., & Stein, M. B. (2014). Feasibility of two modes of treatment delivery for child anxiety in primary care. Behaviour Research and Therapy,60, 60–66. https://doi.org/10.1016/j.brat.2014.06.010.

    Article  PubMed  PubMed Central  Google Scholar 

  • Chorpita, B. F., Taylor, A. A., Francis, S. E., Moffitt, C., & Austin, A. A. (2004). Efficacy of modular cognitive behavior therapy for childhood anxiety disorders. Behavior Therapy,35(2), 263–287. https://doi.org/10.1016/S0005-7894(04)80039-X.

    Article  Google Scholar 

  • Chu, B. C., Crocco, S. T., Arnold, C. C., Brown, R., Southam-Gerow, M. A., & Weisz, J. R. (2015). Sustained implementation of cognitive-behavioral therapy for youth anxiety and depression: Long-term effects of structured training and consultation on therapist practice in the field. Professional Psychology: Research and Practice,46(1), 70–79. https://doi.org/10.1037/a0038000.

    Article  Google Scholar 

  • Cicchetti, D. V., & Feinstein, A. R. (1990). High agreement but low kappa: II. Resolving the paradoxes. Journal of Clinical Epidemiology,43(6), 551–558.

    Article  PubMed  Google Scholar 

  • Clark, D. M., Ehlers, A., McManus, F., Hackmann, A., Fennell, M., Campbell, H.,…, Louis, B. (2003). Cognitive therapy versus fluoxetine in generalized social phobia: A randomized placebo-controlled trial. Journal of Consulting and Clinical Psychology, 71(6), 1058–1067. https://doi.org/10.1037/0022-006x.71.6.10582003-09784-011.

  • Cobham, V. E. (2012). Do anxiety-disordered children need to come into the clinic for efficacious treatment? Journal of Consulting and Clinical Psychology,80(3), 465–476. https://doi.org/10.1037/a0028205.

    Article  PubMed  Google Scholar 

  • Cobham, V. E., Dadds, M. R., & Spence, S. H. (1998). The role of parental anxiety in the treatment of childhood anxiety. Journal of Consulting and Clinical Psychology,66(6), 893–905. https://doi.org/10.1037//0022-006X.66.6.893.

    Article  PubMed  Google Scholar 

  • Craske, M. G., Treanor, M., Conway, C. C., Zbozinek, T., & Vervliet, B. (2014). Maximizing exposure therapy: An inhibitory learning approach. Behaviour Research and Therapy,58, 10–23. https://doi.org/10.1016/j.brat.2014.04.006.

    Article  PubMed  PubMed Central  Google Scholar 

  • Crawley, S. A., Kendall, P. C., Benjamin, C. L., Brodman, D. M., Wei, C., Beidas, R. S., …, Mauro, C. (2013). Brief cognitive-behavioral therapy for anxious youth: feasibility and initial outcomes. Cognitive and Behavioral Practice, 20, 123–133.

    Article  Google Scholar 

  • Creswell, C., Cruddace, S., Gerry, S., Gitau, R., McIntosh, E., Mollison, J., …, Cooper, P. J. (2015). Treatment of childhood anxiety disorder in the context of maternal anxiety disorder: A randomised controlled trial and economic analysis. Health Technology Assessment, 19(38), 1–184, vii–viii. https://doi.org/10.3310/hta19380.

    Article  PubMed  Google Scholar 

  • Cuijpers, P., Weitz, E., Cristea, I. A., & Twisk, J. (2017). Pre-post effect sizes should be avoided in meta-analyses. Epidemiology and Psychiatric Sciences,26(4), 364–368. https://doi.org/10.1017/S2045796016000809.

    Article  PubMed  Google Scholar 

  • de Groot, J., Cobham, V., Leong, J., & McDermott, B. (2007). Individual versus group family-focused cognitive-behaviour therapy for childhood anxiety: Pilot randomized controlled trial. Australian and New Zealand Journal of Psychiatry,41(12), 990–997. https://doi.org/10.1080/00048670701689436.

    Article  PubMed  Google Scholar 

  • Deacon, B., Kemp, J. J., Dixon, L. J., Sy, J. T., Farrell, N. R., & Zhang, A. R. (2013). Maximizing the efficacy of interoceptive exposure by optimizing inhibitory learning: A randomized controlled trial. Behaviour Research and Therapy,51(9), 588–596.

    Article  PubMed  Google Scholar 

  • Feinstein, A. R., & Cicchetti, D. V. (1990). High agreement but low kappa: I. The problems of two paradoxes. Journal of Clinical Epidemiology,43(6), 543–549.

    Article  PubMed  Google Scholar 

  • Flannery-Schroeder, E. C., & Kendall, P. C. (2000). Group and individual cognitive-behavioral treatments for youth with anxiety disorders: A randomized clinical trial. Cognitive Therapy and Research,24(3), 251–278. https://doi.org/10.1023/A:1005500219286.

    Article  Google Scholar 

  • Gallagher, H. M., Rabian, B. A., & McCloskey, M. S. (2004). A brief group cognitive-behavioral intervention for social phobia in childhood. Journal of Anxiety Disorders,18(4), 459–479. https://doi.org/10.1016/S0887-6185(03)00027-6.

    Article  PubMed  Google Scholar 

  • Garcia, L., L, J., Diaz, C., M. D, M., Muela, M., J, A., …, L. (2014). Can parent training for parents with high levels of expressed emotion have a positive effect on their child’s social anxiety improvement? Journal of Anxiety Disorders, 28(8), 812–822. https://doi.org/10.1016/j.janxdis.2014.09.001.

    Article  PubMed  Google Scholar 

  • Gil-Bernal, F., & Hernandez-Guzman, L. (2009). Tratamiento cognitivo-conductual para niños mexicanos con fobia social* [Cognitive-behavioural treatment in Mexican children with social phobia]. Anuario de Psicologia,40(1), 89–104.

    Google Scholar 

  • Ginsburg, G. S., Becker, K. D., Drazdowski, T. K., & Tein, J. Y. (2012). Treating anxiety disorders in inner city schools: Results from a pilot randomized controlled trial comparing CBT and usual care. Child & Youth Care Forum,41(1), 1–19. https://doi.org/10.1007/s10566-011-9156-4.

    Article  Google Scholar 

  • Ginsburg, G. S., & Drake, K. L. (2002). School-based treatment for anxious african-american adolescents: A controlled pilot study. Journal of the American Academy of Child and Adolescent Psychiatry,41(7), 768–775. https://doi.org/10.1097/00004583-200207000-00007.

    Article  PubMed  Google Scholar 

  • Ginsburg, G. S., Kendall, P. C., Sakolsky, D., Compton, S. N., Piacentini, J., Albano, A. M., …, March, J. (2011). Remission after acute treatment in children and adolescents with anxiety disorders: Findings from the CAMS. Journal of Consulting and Clinical Psychology, 79(6), 806–813.

    Article  PubMed  PubMed Central  Google Scholar 

  • Gould, R. A., Otto, M. W., & Pollack, M. H. (1995). A meta-analysis of treatment outcome for panic disorder. Clinical Psychology Review,15, 819–844.

    Article  Google Scholar 

  • Hallgren, K. A. (2012). Computing inter-rater reliability for observational data: An overview and tutorial. Tutorials in Quantitative Methods for Psychology,8(1), 23–34.

    Article  PubMed  PubMed Central  Google Scholar 

  • Hancock, K. M., Swain, J., Hainsworth, C. J., Dixon, A. L., Koo, S., & Munro, K. (2016). Acceptance and commitment therapy versus cognitive behavior therapy for children with anxiety: Outcomes of a randomized controlled trial. Journal of Clinical Child & Adolescent Psychology. https://doi.org/10.1080/15374416.2015.1110822.

    Article  Google Scholar 

  • Hayward, C., Varady, S., Albano, A. M., Thienemann, M., Henderson, L., & Schatzberg, A. F. (2000). Cognitive-behavioral group therapy for social phobia in female adolescents: Results of a pilot study. Journal of the American Academy of Child and Adolescent Psychiatry,39(6), 721–726. https://doi.org/10.1097/00004583-200006000-00010.

    Article  PubMed  Google Scholar 

  • Herbert, J. D., Gaudiano, B. A., Rheingold, A. A., Moitra, E., Myers, V. H., Dalrymple, K. L., et al. (2009). Cognitive behavior therapy for generalized social anxiety disorder in adolescents: A randomized controlled trial. Journal of Anxiety Disorders,23(2), 167–177. https://doi.org/10.1016/j.janxdis.2008.06.004.

    Article  PubMed  Google Scholar 

  • Higa-McMillan, C. K., Francis, S. E., Rith-Najarian, L., & Chorpita, B. F. (2016). Evidence base update: 50 years of research on treatment for child and adolescent anxiety. Journal of Clinical Child and Adolescent Psychology,45(2), 91–113. https://doi.org/10.1080/15374416.2015.1046177.

    Article  PubMed  Google Scholar 

  • Higa-McMillan, C., Kotte, A., Jackson, D., & Daleiden, E. L. (2017). Overlapping and non-overlapping practices in usual and evidence-based care for youth anxiety. The Journal of Behavioral Health Services & Research,44(4), 684–694. https://doi.org/10.1007/s11414-016-9502-2.

    Article  Google Scholar 

  • Higgins, J. P. T., & Green, S. (Eds.). (2011). Cochrane handbook for systematic reviews of interventions. Version 5.1.0. Hoboken, NJ: The Cochrane Collaboration.

    Google Scholar 

  • Hirshfeld-Becker, D. R., Masek, B., Henin, A., Blakely, L. R., Pollock-Wurman, R. A., McQuade, J., …, Biederman, J. (2010). Cognitive behavioral therapy for 4- to 7-year-old children with anxiety disorders: A randomized clinical trial. Journal of Consulting and Clinical Psychology, 78(4), 498–510. https://doi.org/10.1037/a0019055.

    Article  PubMed  Google Scholar 

  • Holmes, M. C., Donovan, C. L., Farrell, L. J., & March, S. (2014). The efficacy of a group-based, disorder-specific treatment program for childhood GAD–a randomized controlled trial. Behaviour Research and Therapy,61, 122–135. https://doi.org/10.1016/j.brat.2014.08.002.

    Article  PubMed  Google Scholar 

  • Hudson, J. L., Newall, C., Rapee, R. M., Lyneham, H. J., Schniering, C. C., Wuthrich, V. M., et al. (2014). The impact of brief parental anxiety management on child anxiety treatment outcomes: A controlled trial. Journal of Clinical Child & Adolescent Psychology,43(3), 370–380. https://doi.org/10.1080/15374416.2013.807734.

    Article  Google Scholar 

  • Hudson, J. L., Rapee, R. M., Deveney, C., Schniering, C. A., Lyneham, H. J., & Bovopoulos, N. (2009). Cognitive-behavioral treatment versus an active control for children and adolescents with anxiety disorders: A randomized trial. Journal of the American Academy of Child and Adolescent Psychiatry,48(5), 533–544. https://doi.org/10.1097/CHI.0b013e31819c2401.

    Article  PubMed  Google Scholar 

  • Ingul, J. M., Aune, T., & Nordahl, H. M. (2014). A randomized controlled trial of individual cognitive therapy, group cognitive behaviour therapy and attentional placebo for adolescent social phobia. Psychotherapy and Psychosomatics,83(1), 54–61. https://doi.org/10.1159/000354672.

    Article  PubMed  Google Scholar 

  • James, A., James, G., Codrey, F., Soler, A., & Choke, A. (2013). Cognitive behavioural therapy for anxiety disorders in children and adolescents (Review). Cochrane Database of Systematic Reviews,6, CD004690.

    Google Scholar 

  • Karbasi, A., Arman, S., & Maracy, M. R. (2010). The efficacy of attendance and semi-attendance group cognitive-behavioral therapy (CBT) on the anxiety disorders of adolescent girls. Journal of Research in Medical Sciences,15(5), 256–263.

    PubMed  PubMed Central  Google Scholar 

  • Kendall, P. C. (1985). Toward a cognitive-behavioral model of child psychopathology and a critique of related interventions. Journal of Abnormal Child Psychology,13, 357–372.

    Article  PubMed  Google Scholar 

  • Kendall, P. C. (1994). Treating anxiety disorders in children: Results of a randomized clinical trial. Journal of Consulting and Clinical Psychology,62, 100–110. https://doi.org/10.1037/0022-006X.62.1.100.

    Article  PubMed  Google Scholar 

  • Kendall, P. C., Flannery-Schroeder, E., Panichelli-Mindel, S. M., Southam-Gerow, M., Henin, A., & Warman, M. (1997). Therapy for youths with anxiety disorders: A second randomized clinical trial. Journal of Consulting and Clinical Psychology,65(3), 366–380.

    Article  PubMed  Google Scholar 

  • Kendall, P. C., Hudson, J. L., Gosch, E., Flannery-Schroeder, E., & Suveg, C. (2008). Cognitive-behavioral therapy for anxiety disordered youth: A randomized clinical trial evaluating child and family modalities. Journal of Consulting and Clinical Psychology,76(2), 282–297. https://doi.org/10.1037/0022-006X.76.2.282.

    Article  PubMed  Google Scholar 

  • Kendall, P. C., Robin, J. A., Hedtke, K. A., Suveg, C., Flannery-Schroeder, E., & Gosch, E. (2005). Considering CBT With anxious youth? Think exposures. Cognitive and Behavioral Practice,12(1), 136–150.

    Article  Google Scholar 

  • Khanna, M. S. (2014). A primer on internet interventions for child anxiety. The Behavior Therapist,37, 122–125.

    Google Scholar 

  • Khanna, M. S., & Kendall, P. C. (2010). Computer-assisted cognitive behavioral therapy for child anxiety: Results of a randomized clinical trial. Journal of Consulting and Clinical Psychology,78(5), 737–745.

    Article  PubMed  Google Scholar 

  • Leong, J., Cobham, V. E., de Groot, J., & McDermott, B. (2009). Comparing different modes of delivery: A pilot evaluation of a family-focused, cognitive-behavioral intervention for anxiety-disordered children. European Child and Adolescent Psychiatry,18(4), 231–239. https://doi.org/10.1007/s00787-008-0723-7.

    Article  PubMed  Google Scholar 

  • Liber, J. M., Van Widenfelt, B. M., Utens, E. M., Ferdinand, R. F., Van der Leeden, A. J., Van Gastel, W., et al. (2008). No differences between group versus individual treatment of childhood anxiety disorders in a randomised clinical trial. Journal of Child Psychology and Psychiatry,49(8), 886–893. https://doi.org/10.1111/j.1469-7610.2008.01877.x.

    Article  PubMed  Google Scholar 

  • Manassis, K., Lee, T. C., Bennett, K., Zhao, X. Y., Mendlowitz, S., Duda, S., …, Wood, J. J. (2014). Types of parental involvement in CBT with anxious youth: a preliminary meta-analysis. Journal of Consulting and Clinical Psychology, 82(6), 1163–1172. https://doi.org/10.1037/a0036969.

    Article  PubMed  Google Scholar 

  • Manassis, K., Mendlowitz, S. L., Scapillato, D., Avery, D., Fiksenbaum, L., Freire, M., … Owens, M. (2002). Group and individual cognitive-behavioral therapy for childhood anxiety disorders: A randomized trial. Journal of the American Academy of Child & Adolescent Psychiatry, 41(12), 1423–1430. https://doi.org/10.1097/00004583-200212000-00013.

    Article  Google Scholar 

  • Manassis, K., Russell, K., & Newton, A. S. (2010). The Cochrane Library and the treatment of childhood and adolescent anxiety disorders: And overview of reviews. Evidence-Base Child Health: A Cochrane Review Journal,5, 541–554.

    Article  Google Scholar 

  • Masia Warner, C., Colognori, D., Brice, C., Herzig, K., Mufson, L., Lynch, C., …, Klein, R. G. (2016). Can school counselors deliver cognitive-behavioral treatment for social anxiety effectively? A randomized controlled trial. Journal of Child Psychology and Psychiatry, 57, 1229–1238. https://doi.org/10.1111/jcpp.12550.

    Article  PubMed  Google Scholar 

  • Masia Warner, C., Fisher, P. H., Shrout, P. E., Rathor, S., & Klein, R. G. (2007). Treating adolescents with social anxiety disorder in school: An attention control trial. Journal of Child Psychology and Psychiatry,48(7), 676–686. https://doi.org/10.1111/j.1469-7610.2007.01737.x.

    Article  PubMed  Google Scholar 

  • Masia-Warner, C., Klein, R. G., Dent, H. C., Fisher, P. H., Alvir, J., Albano, A. M., et al. (2005). School-based intervention for adolescents with social anxiety disorder: Results of a controlled study. Journal of Abnormal Child Psychology,33(6), 707–722. https://doi.org/10.1007/s10802-005-7649-z.

    Article  PubMed  Google Scholar 

  • Melfsen, S., Kuhnemund, M., Schwieger, J., Warnke, A., Stadler, C., Poustka, F., et al. (2011). Cognitive behavioral therapy of socially phobic children focusing on cognition: A randomised wait-list control study. Child and Adolescent Psychiatry and Mental Health,5(1), 5. https://doi.org/10.1186/1753-2000-5-5.

    Article  PubMed  PubMed Central  Google Scholar 

  • Mendlowitz, S. L., Manassis, K., Bradley, S., Scapillato, D., Miezitis, S., & Shaw, B. F. (1999). Cognitive-behavioral group treatments in childhood anxiety disorders: The role of parental involvement. Journal of the American Academy of Child and Adolescent Psychiatry,38(10), 1223–1229. https://doi.org/10.1097/00004583-199910000-00010.

    Article  PubMed  Google Scholar 

  • Monga, S., Rosenbloom, B. N., Tanha, A., Owens, M., & Young, A. (2015). Comparison of child-parent and parent-only cognitive-behavioral therapy programs for anxious children aged 5 to 7 years: Short- and long-term outcomes. Journal of the American Academy of Child and Adolescent Psychiatry,54(2), 138–146. https://doi.org/10.1016/j.jaac.2014.10.008.

    Article  PubMed  Google Scholar 

  • Muris, P., Mayer, B., Bartelds, E., Tierney, S., & Bogie, N. (2001). The revised version of the Screen for Child Anxiety Related Emotional Disorders (SCARED-R): Treatment sensitivity in an early intervention trial for childhood anxiety disorders. British Journal of Clinical Psychology,40(Pt 3), 323–336. https://doi.org/10.1348/014466501163724.

    Article  PubMed  Google Scholar 

  • Muris, P., Meesters, C., & van Melick, M. (2002). Treatment of childhood anxiety disorders: A preliminary comparison between cognitive-behavioral group therapy and a psychological placebo intervention. Journal of Behavior Therapy and Experimental Psychiatry,33(3–4), 143–158. https://doi.org/10.1016/S0005-7916(02)00025-3.

    Article  PubMed  Google Scholar 

  • Nauta, M. H., Scholing, A., Emmelkamp, P. M., & Minderaa, R. B. (2001). Cognitive-behavioural therapy for anxiety disordered children in a clinical setting: Does additional cognitive parent training enhance treatment effectiveness? Clinical Psychology & Psychotherapy,8(5), 330–340. https://doi.org/10.1002/cpp.314.

    Article  Google Scholar 

  • Nauta, M. H., Scholing, A., Emmelkamp, P. M., & Minderaa, R. B. (2003). Cognitive-behavioral therapy for children with anxiety disorders in a clinical setting: No additional effect of a cognitive parent training. Journal of the American Academy of Child and Adolescent Psychiatry,42(11), 1270–1278. https://doi.org/10.1097/01.chi.0000085752.71002.93.

    Article  PubMed  Google Scholar 

  • Nilsen, T. S., Eisemann, M., & Kvernmo, S. (2013). Predictors and moderators of outcome in child and adolescent anxiety and depression: A systematic review of psychological treatment studies. European Child and Adolescent Psychiatry,22(2), 69–87. https://doi.org/10.1007/s00787-012-0316-3.

    Article  PubMed  Google Scholar 

  • NIMH. (2018). Child and adolescent treatment and preventive intervention research branch: Areas of emphasis. Retrieved March 1, 2018, from https://www.nimh.nih.gov/about/organization/dsir/child-and-adolescent-treatment-and-preventive-intervention-research-branch/index.shtml.

  • O’Brien, F., Olden, N., & Migone, M. (2007). Group cognitive behavioural therapy for children with anxiety disorder—An evaluation of the ‘Friends for Youth’ programme. Irish Journal of Psychological Medicine,24(1), 5–12. https://doi.org/10.1017/S0790966700010065.

    Article  PubMed  Google Scholar 

  • Olivares, J., Olivares-Olivares, P. J., Rosa-Alcazar, A. I., Montesinos, L., & Macia, D. (2014). The contribution of the therapist’s competence in the treatment of adolescents with generalized social phobia. Psicothema,26(4), 483–489. https://doi.org/10.7334/psicothema2014.69.

    Article  PubMed  Google Scholar 

  • Olivares-Olivares, P. J., Rosa-Alcázar, A. I., & Olivares-Rodriguez, J. (2008). Does individual attention improve the effect of group treatment of adolescents with social phobia? International Journal of Clinical and Health Psychology,8(2), 465–481.

    Google Scholar 

  • Olivares-Rodriguez, J., Rosa-Alcazar, A. I., & Olivares-Olivares, P. J. (2006). The relevance of the individualized attention in the treatment with adolescents under generalized social phobia. International Journal of Clinical and Health Psychology,6(3), 565–580.

    Google Scholar 

  • Ost, L. G., Cederlund, R., & Reuterskiold, L. (2015). Behavioral treatment of social phobia in youth: Does parent education training improve the outcome? Behaviour Research and Therapy,67, 19–29. https://doi.org/10.1016/j.brat.2015.02.001.

    Article  PubMed  Google Scholar 

  • PCORI. (2018). PCORI funding announcement: Pharmacological treatment of anxiety disorders in children, adolescents and/or young adults [Press release]. Retrieved March 1, 2018, from https://www.pcori.org/sites/default/files/PCORI-PFA-2018-Cycle-1-Pediatric-Anxiety.pdf.

  • Peris, T. S., Caporino, N. E., O’Rourke, S., Kendall, P. C., Walkup, J. T., Albano, A. M., …, Compton, S. N. (2017). Therapist-reported features of exposure tasks that predict differential treatment outcomes for youth with anxiety. Journal of the American Academy of Child & Adolescent Psychiatry, 56(12), 1043–1052. https://doi.org/10.1016/j.jaac.2017.10.001.

    Article  Google Scholar 

  • Peris, T. S., Compton, S. N., Kendall, P. C., Birmaher, B., Sherrill, J., March, J., …, Piacentini, J. (2015). Trajectories of change in youth anxiety during cognitive-behavior therapy. Journal of Consulting and Clinical Psychology, 83(2), 239–252. https://doi.org/10.1037/a0038402.

    Article  PubMed  Google Scholar 

  • Pincus, D. B., May, J. E., Whitton, S. W., Mattis, S. G., & Barlow, D. H. (2010). Cognitive-behavioral treatment of panic disorder in adolescence. Journal of Clinical Child & Adolescent Psychology,39(5), 638–649. https://doi.org/10.1080/15374416.2010.501288.

    Article  Google Scholar 

  • POTS. (2004). Cognitive-behavior therapy, sertraline, and their combination for children and adolescents with obsessive-compulsive disorder: The Pediatric OCD Treatment Study (POTS) Randomized Controlled Trial. JAMA Journal of the American Medical Association,292, 1969–1976.

    Article  Google Scholar 

  • Rapee, R. M., Abbott, M. J., & Lyneham, H. J. (2006). Bibliotherapy for children with anxiety disorders using written materials for parents: A randomized controlled trial. Journal of Consulting and Clinical Psychology,74(3), 436–444. https://doi.org/10.1037/0022-006X.74.3.436.

    Article  PubMed  Google Scholar 

  • Reid, A. M., Guzick, A. G., Fernandez, A. G., Deacon, B., McNamara, J. P. H., Geffken, G. R., …, Striley, C. W. (2018). Exposure therapy for youth with anxiety: Utilization rates and predictors of implementation in a sample of practicing clinicians from across the United States. Journal of Anxiety Disorders, 58, 8–17. https://doi.org/10.1016/j.janxdis.2018.06.002.

    Article  PubMed  Google Scholar 

  • Rodriguez, J. O., Alcazar, A. I., & Rodriguez, J. A. (2005). Early detection and treatment of adolescents with generalized social phobia. Psicothema,17(1), 1–8.

    Google Scholar 

  • Rosa-Alcazar, A. I., Boix, M. A., & Olivares-Olivares, P. J. (2013). Contributions of cognitive restructuring in the treatment of social phobia in adolescents. Behavioral Psychology/Psicologia Conductual: Revista Internacional Clinica y de la Salud Psicologia Conductual Revista Internacional de Psicologia Clinica de la Salud,21, 6–23.

    Google Scholar 

  • Rosa-Alcázar, A. I., Olivares-Olivares, P. J., & Olivares, J. (2009). Papel de los efectos inespecíficos en el tratamiento psicológico de adolescentes con fobia social. Anuario de Psicología,40, 43–61.

  • Rosa-Alcázar, A. I., Olivares-Rodríguez, J., & Olivares-Olivares, P. (2007). The role of planned interaction in the treatment of generalized social phobia. Terapia psicológica,25(2), 205–212.

    Article  Google Scholar 

  • Sánchez, G., Raquel, Rodríguez, & José, O. (2009). Intervención temprana en niños y adolescentes con fobia social. Anuario de psicología/The UB Journal of Psychology,40(1), 75–88.

    Google Scholar 

  • Sanchez-Garcia, R., & Olivares, J. (2009). Effectiveness of a program for early detection/intervention in children/adolescents with generalized social phobia. Anales De Psicologia,25, 241–249.

    Google Scholar 

  • Santucci, L. C., & Ehrenreich-May, J. (2013). A randomized controlled trial of the child anxiety multi-day program (CAMP) for separation anxiety disorder. Child Psychiatry and Human Development,44(3), 439–451. https://doi.org/10.1007/s10578-012-0338-6.

    Article  PubMed  PubMed Central  Google Scholar 

  • Schneider, S., Blatter-Meunier, J., Herren, C., Adornetto, C., In-Albon, T., & Lavallee, K. (2011). Disorder-specific cognitive-behavioral therapy for separation anxiety disorder in young children: A randomized waiting-list-controlled trial. Psychotherapy and Psychosomatics,80(4), 206–215. https://doi.org/10.1159/000323444.

    Article  PubMed  Google Scholar 

  • Schneider, S., Blatter-Meunier, J., Herren, C., In-Albon, T., Adornetto, C., Meyer, A., et al. (2013). The efficacy of a family-based cognitive-behavioral treatment for separation anxiety disorder in children aged 8-13: A randomized comparison with a general anxiety program. Journal of Consulting and Clinical Psychology,81(5), 932–940. https://doi.org/10.1037/a0032678.

    Article  PubMed  Google Scholar 

  • Shortt, A. L., Barrett, P. M., & Fox, T. L. (2001). Evaluating the FRIENDS program: A cognitive-behavioral group treatment for anxious children and their parents. Journal of Clinical Child Psychology,30(4), 525–535. https://doi.org/10.1207/S15374424JCCP3004_09.

    Article  PubMed  Google Scholar 

  • Silk, J. S., Tan, P. Z., Ladouceur, C. D., Meller, S., Siegle, G. J., McMakin, D. L., …,Ryan, N. D. (2018). A randomized clinical trial comparing individual cognitive behavioral therapy and child-centered therapy for child anxiety disorders. Journal of Clinical Child & Adolescent Psychology, 47(4), 542–554. https://doi.org/10.1080/15374416.2016.1138408.

    Article  Google Scholar 

  • Silverman, W. K., Kurtines, W. M., Ginsburg, G. S., Weems, C. F., Lumpkin, P. W., & Carmichael, D. H. (1999). Treating anxiety disorders in children with group cognitive-behaviorial therapy: A randomized clinical trial. Journal of Consulting and Clinical Psychology,67(6), 995–1003. https://doi.org/10.1037/0022-006X.67.6.995.

    Article  PubMed  Google Scholar 

  • Silverman, W. K., Kurtines, W. M., Jaccard, J., & Pina, A. A. (2009). Directionality of change in youth anxiety treatment involving parents: An initial examination. Journal of Consulting and Clinical Psychology,77(3), 474–485. https://doi.org/10.1037/a0015761.

    Article  PubMed  PubMed Central  Google Scholar 

  • Simpson, H. B., Foa, E. B., Liebowitz, M. R., Ledley, D. R., Huppert, J. D., Cahill, S., …, Petkova, E. (2008). A randomized, controlled trial of cognitive-behavioral therapy for augmenting pharmacotherapy in obsessive-compulsive disorder. American Journal of Psychiatry, 165(5), 621–630. https://doi.org/10.1176/appi.ajp.2007.07091440.

    Article  PubMed  Google Scholar 

  • Siqueland, L., Rynn, M., & Diamond, G. S. (2005). Cognitive behavioral and attachment based family therapy for anxious adolescents: Phase I and II studies. Journal of Anxiety Disorders,19(4), 361–381. https://doi.org/10.1016/j.janxdis.2004.04.006.

    Article  PubMed  Google Scholar 

  • Southam-Gerow, M. A., Weisz, J. R., Chu, B. C., McLeod, B. D., Gordis, E. B., & Connor-Smith, J. K. (2010). Does cognitive behavioral therapy for youth anxiety outperform usual care in community clinics? An initial effectiveness test. Journal of the American Academy of Child and Adolescent Psychiatry,49, 1043–1052.

    Article  PubMed  PubMed Central  Google Scholar 

  • Spence, S. H., Donovan, C., & Brechman-Toussaint, M. (2000). The treatment of childhood social phobia: The effectiveness of a social skills training-based, cognitive-behavioural intervention, with and without parental involvement. Journal of Child Psychology and Psychiatry,41(6), 713–726. https://doi.org/10.1111/1469-7610.00659.

    Article  PubMed  Google Scholar 

  • Spence, S. H., Donovan, C. L., March, S., Gamble, A., Anderson, R. E., Prosser, S., et al. (2011). A randomized controlled trial of online versus clinic-based CBT for adolescent anxiety. Journal of Consulting and Clinical Psychology,79(5), 629–642. https://doi.org/10.1037/a0024512.

    Article  PubMed  Google Scholar 

  • Spence, S. H., Holmes, J. M., March, S., & Lipp, O. V. (2006). The feasibility and outcome of clinic plus internet delivery of cognitive-behavior therapy for childhood anxiety. Journal of Consulting and Clinical Psychology,74(3), 614–621. https://doi.org/10.1037/0022-006X.74.3.614.

    Article  PubMed  Google Scholar 

  • Stewart, R. E., & Chambless, D. L. (2009). Cognitive-behavioral therapy for adult anxiety disorders in clinical practice: A meta-analysis of effectiveness studies. Journal of Consulting and Clinical Psychology,77(4), 595–606. https://doi.org/10.1037/a0016032.

    Article  PubMed  Google Scholar 

  • Stewart, E., Frank, H., Benito, K., Wellen, B., Herren, J., Skriner, L. C., et al. (2016). Exposure therapy practices and mechanism endorsement: A survey of specialty clinicians. Professional Psychology: Research and Practice,47, 303–311. https://doi.org/10.1037/pro0000094.

    Article  Google Scholar 

  • Storch, E., Bussing, R., Small, B., Geffken, G., McNamara, J., Rahman, O., …, Murphy, T. (2013). Randomized, placebo-controlled trial of cognitive-behavioral therapy alone or combined with sertraline in the treatment of pediatric obsessive-compulsive disorder. Behavior Research and Therapy, 51, 823–829.

    Article  PubMed  PubMed Central  Google Scholar 

  • Storch, E. A., Salloum, A., King, M. A., Crawford, E. A., Andel, R., McBride, N. M., et al. (2015). A randomized controlled trial in community mental health centers of computer-assisted cognitive behavioral therapy versus treatment as usual for children with anxiety. Depress Anxiety,32(11), 843–852. https://doi.org/10.1002/da.22399.

    Article  PubMed  Google Scholar 

  • Taylor, J. H., Lebowitz, E. R., Jakubovski, E., Coughlin, C. G., Silverman, W. K., & Bloch, M. H. (2018). Monotherapy insufficient in severe anxiety? Predictors and moderators in the child/adolescent anxiety multimodal study. Journal of Clinical Child & Adolescent Psychology,47(2), 266–281. https://doi.org/10.1080/15374416.2017.1371028.

    Article  Google Scholar 

  • Viera, A. J., & Garrett, J. M. (2005). Understanding interobserver agreement: The kappa statistic. Family Medicine,37(5), 360–363.

    PubMed  Google Scholar 

  • Walkup, J. T., Albano, A. M., Piacentini, J. C., Birmaher, B., Compton, S. N., Sherrill, J. T., …, Kendall, P. C. (2008). Cognitive behavioral therapy, sertraline, or a combination in childhood anxiety. The New England Journal of Medicine, 359, 2753–2766. https://doi.org/10.1056/nejmoa0804633

    Article  PubMed  Google Scholar 

  • Wang, Z., Whiteside, S., Sim, L., Farah, W., Morrow, A., Alsawas, M., …, Murad, M. (2017b). Anxiety in Children. Comparative Effectiveness Review No. 192. (Prepared by the Mayo Clinic Evidence-based Practice Center under Contract No. 290-2015-00013-I.) AHRQ Publication No. 17-EHC023-EF. Rockville, MD: Agency for Healthcare Research and Quality.

  • Wang, Z., et al. (2017a). Comparative effectiveness and safety of cognitive behavioral therapy and pharmacotherapy for childhood anxiety disorders: A systematic review and meta-analysis. JAMA Pediatrics,171(11), 1049–1056. https://doi.org/10.1001/jamapediatrics.2017.3036.

    Article  PubMed  PubMed Central  Google Scholar 

  • Waters, A. M., Ford, L. A., Wharton, T. A., & Cobham, V. E. (2009). Cognitive-behavioural therapy for young children with anxiety disorders: Comparison of a Child + Parent condition versus a Parent Only condition. Behaviour Research and Therapy,47(8), 654–662. https://doi.org/10.1016/j.brat.2009.04.008.

    Article  PubMed  Google Scholar 

  • Weersing, V. R., Rozenman, M., & Gonzalez, A. (2009). Core components of therapy in youth: Do we know what to disseminate? Behavior Modification,33(1), 24–47.

    Article  PubMed  Google Scholar 

  • Weisz, J. R., Kuppens, S., Eckshtain, D., Ugueto, A. M., Hawley, K. M., & Jensen-Doss, A. (2013). Performance of evidence-based youth psychotherapies compared with usual clinical care: A multilevel meta-analysis. JAMA Psychiatry,70(7), 750–761. https://doi.org/10.1001/jamapsychiatry.2013.1176.

    Article  PubMed  Google Scholar 

  • Wergeland, G. J., Fjermestad, K. W., Marin, C. E., Haugland, B. S., Bjaastad, J. F., Oeding, K., et al. (2014). An effectiveness study of individual vs. group cognitive behavioral therapy for anxiety disorders in youth. Behaviour Research and Therapy,57, 1–12. https://doi.org/10.1016/j.brat.2014.03.007.

    Article  PubMed  Google Scholar 

  • Whiteside, S. P. H., Ale, C. M., Young, B., Dammann, J., Tiede, M. S., & Biggs, B. K. (2015). The feasibility of improving CBT for childhood anxiety disorders through a dismantling study. Behaviour Research and Therapy,73, 83–89. https://doi.org/10.1016/j.brat.2015.07.011.

    Article  PubMed  Google Scholar 

  • Whiteside, S. P., Ale, C. M., Young, B., Olsen, M. W., Biggs, B. K., Gregg, M. S., …, Homan, K. (2016). The length of child anxiety treatment in a regional health system. Child Psychiatry & Human Development, 47(6), 985–992. https://doi.org/10.1007/s10578-016-0628-5.

    Article  Google Scholar 

  • Whiteside, S. P. H., Deacon, B. J., Benito, K., & Stewart, E. (2016b). Factors associated with practitioners’ use of exposure therapy for childhood anxiety disorders. Journal of Anxiety Disorders,40, 29–36. https://doi.org/10.1016/j.janxdis.2016.04.001.

    Article  PubMed  PubMed Central  Google Scholar 

  • Whiteside, S. P. H., Sattler, A., Ale, C. M., Young, B., Hillson Jensen, A., Gregg, M. S., et al. (2016c). The use of exposure therapy for child anxiety disorders in a medical center. Professional Psychology: Research and Practice,47, 206–214. https://doi.org/10.1037/pro0000077.

    Article  Google Scholar 

  • Wood, J. J., Piacentini, J. C., Southam-Gerow, M., Chu, B. C., & Sigman, M. (2006). Family cognitive behavioral therapy for child anxiety disorders. Journal of the American Academy of Child and Adolescent Psychiatry,45(3), 314–321. https://doi.org/10.1097/01.chi.0000196425.88341.b0.

    Article  PubMed  Google Scholar 

Download references

Funding

This project was funded under Contract No. HHSA290201500013I, Task Order HHSA29032002T, from the Agency for Healthcare Research and Quality (AHRQ) and U.S. Department of Health and Human Services (HHS).

Author information

Authors and Affiliations

  1. Department of Psychiatry and Psychology, Mayo Clinic, Mayo Bldg West 11, 200 First St., SW, Rochester, MN, 55905, USA

    Stephen P. H. Whiteside, Leslie A. Sim & Daniel R. Hilliker

  2. Robert D. and Patricia E. Kern Center for Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA

    Allison S. Morrow, Wigdan H. Farah, M. Hassan Murad & Zhen Wang

Authors
  1. Stephen P. H. Whiteside
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Leslie A. Sim
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Allison S. Morrow
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Wigdan H. Farah
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Daniel R. Hilliker
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. M. Hassan Murad
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Zhen Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Stephen P. H. Whiteside.

Ethics declarations

Conflict of interest

The authors of this manuscript are solely responsible for its content. The content does not necessarily represent the official views of or imply endorsement by AHRQ or HHS. Role of the Funder: A representative from AHRQ served as a contracting officer’s technical representative and provided technical assistance during the conduct of the full evidence report and provided comments on draft versions of the full evidence report. AHRQ did not directly participate in the literature search, determination of study eligibility criteria, data analysis or interpretation, or preparation, review, or approval of the manuscript for publication.

Ethical Approval

This article does not contain any studies with human participants performed by any of the authors.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Appendix

Appendix

See Table 5.

Table 5 Characteristics of included studies
Full size table

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Whiteside, S.P.H., Sim, L.A., Morrow, A.S. et al. A Meta-analysis to Guide the Enhancement of CBT for Childhood Anxiety: Exposure Over Anxiety Management. Clin Child Fam Psychol Rev 23, 102–121 (2020). https://doi.org/10.1007/s10567-019-00303-2

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10567-019-00303-2

Keywords

Search

Navigation