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

Practice Corner Author: Cameron Mosley, Center for the Study and Treatment of Anxious Youth (CSTAY), Palo Alto University

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

Article Authors: Jennifer S. Silk, Patricia Z. Tan, Cecile D. Ladouceur, Suzanne Meller, Greg J. Siegle, Dana L. McMakin, Erika E. Forbes, Ronald E. Dahl, Phillip C. Kendall, Anthony Mannarino, & Neal D. Ryan

Why is this article relevant to practice?

Many therapists may be hesitant to engage in exposure therapy with their patients, fearing that it could result in too much distress or make the child’s symptoms worse (Deacon, Dixon, & Lickel, 2013). This article shows that the benefits of using child-focused CBT, which includes exposure therapy, likely outweigh the costs and provide gains beyond supportive therapy. Clinicians who are not using exposure with anxious youth patients should consider gaining training in this valuable treatment module.

What are the key takeaways from the article?

• 133 children ages 9-14 with a primary diagnosis of generalized anxiety disorder, separation anxiety disorder, or social anxiety disorder participated in the study. Participants were randomly assigned on a 2:1 ratio to complete 9 sessions of CBT (Coping Cat) or supportive therapy (child-centered therapy [CCT]).
• Most youth who completed both CBT and supportive therapy experienced a clinically significant reduction in anxiety symptoms: 71.1% from CBT and 55.8% from supportive therapy.
• After treatment, youth in the CBT condition were significantly more likely to reach full recovery, which generalized to secondary anxiety diagnoses.
• At one-year follow-up, children in the CBT group were more likely to be considered “treatment responders.”
• Youth who completed CBT experienced lower levels of negative emotions when confronting anxiety-provoking situations in their daily lives.

What do the authors say are the limitations of the article?

• The study was part of a larger project within a research clinic and excluded complex presentations (e.g., autism spectrum disorder, suicidality). In a community setting, there may be greater barriers to successful treatment implementation.
• 89% of children in the sample identified as Caucasian. The treatment effects in the current study may not generalize to children with ethnic minority identities.
• Participants were not assessed for anxiety symptoms beyond the one-year follow-up. It is unknown whether children’s treatment gains lasted beyond this time.

Helpful links:

• How to Treat Anxiety with Exposure and Response Prevention: https://www.youtube.com/watch?v=NjQZhC7bKps
• Behavioral Treatment for Kids with Anxiety: https://childmind.org/article/behavioral-treatment-kids-anxiety/

Full Article Reference: 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. doi:10.1080/15374416.2016.1138408