Skip to main content

Advertisement

SpringerLink
Log in

Treating Anxiety Disorders in Inner City Schools: Results from a Pilot Randomized Controlled Trial Comparing CBT and Usual Care

  • Original Paper
  • Published:
Child & Youth Care Forum Aims and scope Submit manuscript

Abstract

Background

The effectiveness of cognitive-behavioral treatment (CBT) in inner city schools, when delivered by novice CBT clinicians, and compared to usual care (UC), is unknown.

Objective

This pilot study addressed this issue by comparing a modular CBT for anxiety disorders to UC in a sample of 32 volunteer youth (mean age 10.28 years, 63% female, 84% African American) seen in school-based mental health programs.

Methods

Youth were randomly assigned to CBT (n = 17) or UC (n = 15); independent evaluators conducted diagnostic interviews with children and parents at pre- and post-intervention, and at a one-month follow-up.

Results

Based on intent-to-treat analyses, no differences were found in response rates between groups with 50 and 42% of the children in CBT, compared to 46 and 57% in UC no longer meeting criteria for an anxiety disorder at post-treatment and follow-up respectively. Similar improvements in global functioning were also found in both treatment groups. Baseline predictors of a positive treatment response included lower anxiety, fewer maladaptive thoughts, less exposure to urban hassles, and lower levels of parenting stress. Therapist use of more CBT session structure elements and greater competence in implementing these elements was also related to a positive treatment response.

Conclusions

Findings from this small pilot failed to show that CBT was superior to UC when delivered by school-based clinicians. Large scale comparative effectiveness trials are needed to determine whether CBT leads to superior clinical outcomes prior to dissemination.

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

  • Abidin, R. R. (1995). Parenting stress index manual (3rd ed.). Lutz, FL: Psychological Assessment Resources, Inc.

    Google Scholar 

  • Barrington, J., Prior, M., Richardson, M., & Allen, K. (2005). Effectiveness of CBT versus standard treatment for childhood anxiety disorders in a community clinic setting. Behaviour Change, 22(1), 29–43.

    Article  Google Scholar 

  • Beidel, D. C., & Turner, S. M. (1988). Comorbidity of test anxiety and other anxiety disorders in children. Journal of Abnormal Child Psychology, 16(3), 275–287.

    Article  PubMed  Google Scholar 

  • Birmaher, B., Khetarpal, S., Brent, D., & Cully, M. (1997). The screen for child anxiety related emotional disorders (SCARED): Scale construction and psychometric characteristics. Journal of the American Academy of Child and Adolescent Psychiatry, 36(4), 545–553.

    Article  PubMed  Google Scholar 

  • Birmaher, B., Brent, D. A., & Chiappetta, L. (1999). Psychometric properties of the screen for child anxiety related emotional disorders (SCARED): A replication study. Journal of the American Academy of Child and Adolescent Psychiatry, 38(10), 1230–1236.

    Article  PubMed  Google Scholar 

  • Boulet, J., & Boss, M. W. (1991). Reliability and validity of the brief symptom inventory. Psychological Assessment, 3(3), 433–437.

    Article  Google Scholar 

  • Chorpita, B. F., Taylor, A. A., Francis, S. E., Moffitt, C. E., & Austin, A. A. (2004). Efficacy of modular cognitive behavior therapy for childhood anxiety disorders. Behavior Therapy, 35, 263–287.

    Article  Google Scholar 

  • Costello, E. J., Egger, H. L., & Angold, A. (2004). Developmental epidemiology of anxiety disorders. In T. H. Ollendick & J. S. March (Eds.), Phobic and anxiety disorders in children and adolescents: A clinician’s guide to effective psychosocial and pharmacological interventions (pp. 61–91). New York, NY: Oxford University Press.

    Google Scholar 

  • Derogatis, L. R., & Melisaratos, N. (1983). The brief symptom inventory: An introductory report. Psychological Medicine, 13(03), 595–605.

    Article  PubMed  Google Scholar 

  • Ehrenreich-May, J., & Bilek, E. L. (2011). Universal prevention of anxiety and depression in a recreational camp setting: An initial open trial. Child and Youth Care Forum.

  • Ginsburg, G. S., Becker, K. D., Kingery, J. N., & Nichols, T. (2008). Transporting CBT for childhood anxiety disorders into inner-city school-based mental health clinics. Cognitive and Behavioral Practice, 15(2), 148–158.

    Article  Google Scholar 

  • Ginsburg, G. S., Silva, S. G., Jacobs, R. H., Tonev, S., Hoyle, R. H., Kingery, J. N., et al. (2009). Cognitive measures of adolescent depression: Unique or unitary constructs? Journal of Clinical Child and Adolescent Psychology, 38(6), 790–802.

    Article  PubMed  Google Scholar 

  • Ginsburg, G. S., Kendall, P. K., Sakolsky, D., Compton, S. N., Piacentini, J., Albano et al. (2011). Remission after acute treatment in children and adolescents with anxiety disorders: Findings from the CAMS. Journal of Consulting and Clinical Psychology.

  • Goodman, R. (1997). The strengths and difficulties questionnaire: A research note. Journal of Child Psychology and Psychiatry, 38(5), 581–586.

    Article  PubMed  Google Scholar 

  • Goodman, R., Meltzer, H., & Bailey, V. (2003). The strengths and difficulties questionnaire: A pilot study on the validity of the self-report version. International Review of Psychiatry, 15(1–2), 173–177.

    Article  PubMed  Google Scholar 

  • Guy, W. (ed.) (1976). ECDEU assessment manual for psychopharmacology, revised. Rockville, MD: U.S. Dept. of Health, Education, and Welfare, Public Health Service, Alcohol, Drug Abuse, and Mental Health Administration, NIMH Psychopharmacology Research Branch, Division of Extramural Research Programs.

  • Kendall, P. C. (1990). Coping cat workbook. Ardmore, PA: Workbook Publishing.

    Google Scholar 

  • Kendall, P. C. (1994). Treating anxiety disorders in children: Results of a randomized clinical trial. Journal of Consulting and Clinical Psychology, 62(1), 100–110.

    Article  PubMed  Google Scholar 

  • Kendall, P. C., Flannery-Schroeder, E., Panichelli-Mindel, S., 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 

  • Kraemer, H. C., Mintz, J., Noda, A., Tinklenberg, J., & Yesavage, J. A. (2006). Caution regarding the use of pilot studies to guide power calculations for study proposals. Archives of General Psychiatry, 63(5), 484–489.

    Article  PubMed  Google Scholar 

  • Little, R. J., & Rubin, D. B. (1987). Statistical analysis with missing data. New York, NY: J. Wiley & Sons.

    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.

    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.

    Article  PubMed  Google Scholar 

  • Miller, D. B., & Townsend, A. (2005). Urban hassles as chronic stressors and adolescent mental health: The urban hassles index. Brief Treatment and Crisis Intervention, 5(1), 85–94.

    Article  Google Scholar 

  • Miller, D. B., Webster, S. E., & MacIntosh, R. (2002). What’s there and what’s not: Measuring daily hassles in urban African American adolescents. Research on Social Work Practice, 12(3), 375–388.

    Article  Google Scholar 

  • Najman, J. M., Williams, G. M., Nikles, J., Spence, S., Bor, W., O’Callaghan, M., et al. (2000). Mothers’ mental illness and child behavior problems: Cause-effect association or observation bias? Journal of the American Academy of Child and Adolescent Psychiatry, 39(5), 592–602.

    Article  PubMed  Google Scholar 

  • Sarason, S. B., Davidson, K. S., Lighthall, F. F., Waite, R. R., & Ruebush, B. K. (1960). Anxiety in elementary school children Oxford. England: John Wiley.

    Google Scholar 

  • Schafer, J. L. (1997). Analysis of incomplete multivariate data. London: Chapman & Hall.

    Book  Google Scholar 

  • Schniering, C. A., & Lyneham, H. J. (2007). The children’s automatic thoughts scale in a clinical sample: Psychometric properties and clinical utility. Behaviour Research and Therapy, 45(8), 1931–1940.

    Article  PubMed  Google Scholar 

  • Schniering, C. A., & Rapee, R. M. (2002). Development and validation of a measure of children’s automatic thoughts: The children’s automatic thoughts scale. Behaviour Research and Therapy, 40(9), 1091–1109.

    Article  PubMed  Google Scholar 

  • Shaffer, D., Gould, M. S., Brasic, J., Ambrosini, P., Fisher, P., Bird, H., et al. (1983). A children’s global assessment scale (CGAS). Archives of General Psychiatry, 40(11), 1228–1231.

    Article  PubMed  Google Scholar 

  • Silverman, W. K., & Albano, A. M. (1996). The anxiety disorders interview schedule for children for DSM-IV: (Child and parent versions). San Antonio, TX: Psychological Corporation.

    Google Scholar 

  • Silverman, W. K., Kurtines, W. M., Ginsburg, G. S., Weems, C. F., Rabian, B., & Serafini, L. T. (1999a). Contingency management, self-control, and education support in the treatment of childhood phobic disorders: A randomized clinical trial. Journal of Consulting and Clinical Psychology, 67, 675–687.

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  • Silverman, W. K., Pina, A. A., & Viswesvaran, C. (2008). Evidence-based psychosocial treatments for phobic and anxiety disorders in children and adolescents. Journal of Clinical Child and Adolescent Psychology, 37(1), 105–130.

    Article  PubMed  Google Scholar 

  • Singer, J. D., & Willett, J. B. (2003). Applied longitudinal data analysis: Modeling change and event occurrence. New York, NY: Oxford University Press.

    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(10), 1043–1052.

    Article  PubMed  Google Scholar 

  • Taylor, L. K., & Weems, C. F. (2011). Cognitive-behavior therapy for disaster exposed youth with posttraumatic stress: Results from a multiple-baseline examination. Behavior Therapy, 42, 349–363.

    Article  PubMed  Google Scholar 

  • Treadwell, K. R. H., & Kendall, P. C. (1996). Self-talk in youth with anxiety disorders: States of mind, content specificity, and treatment outcome. Journal of Consulting and Clinical Psychology, 64(5), 941–950.

    Article  PubMed  Google Scholar 

  • Walkup, J. T., Albano, A. M., Piacentini, J., Birmaher, B., Compton, S. N., Sherrill, J. T., et al. (2008). Cognitive behavioral therapy, sertraline, or a combination in childhood anxiety. New England Journal of Medicine, 359(26), 2753–2766.

    Article  PubMed  Google Scholar 

  • Weems, C. F. (2008). Making the need salient and the benefits clear: A commentary on anxiety and depression focused mental health checkups for children and adolescents. Clinical Psychology: Science and Practice, 15, 212–216.

    Article  Google Scholar 

  • Weems, C. F., Taylor, L. K., Costa, N. M., Marks, A. B., Romano, D. M., Verrett, S. L., et al. (2009). Effect of a school-based test anxiety intervention in ethnic minority youth exposed to Hurricane Katrina. Journal of Applied Developmental Psychology, 30, 218–226.

    Article  Google Scholar 

  • Weems, C. F., Scott, B. G., Taylor, L. K., Cannon, M. F., Romano, D. M., Perry, A. M., et al. (2010). Test anxiety prevention and intervention programs in schools: Program development and rationale. School Mental Health, 2, 62–71.

    Article  Google Scholar 

  • Weist, M. D., & Evans, S. W. (2005). Expanded school mental health: Challenges and opportunities in an emerging field. Journal of Youth and Adolescence, 34(1), 3–6.

    Article  Google Scholar 

  • Weisz, J.R., Chorpita, B.F., Palinkas, L.A., Schoenwald, S.K., Miranda, J., Bearman et al., & the Research Network on Youth Mental Health (2011). Testing standard and modular designs for psychotherapy treating depression, anxiety, and conduct problems in youth: A randomized effectiveness trial. Archives of General Psychiatry. doi:10.1001/archgenpsychiatry.2011.147.

  • Zatz, S., & Chassin, L. (1985). Cognitions of test-anxious children under naturalistic test-taking conditions. Journal of Consulting and Clinical Psychology, 53(3), 393–401.

    Article  PubMed  Google Scholar 

Download references

Acknowledgment

This pilot study was supported by a grant from the National Institute of Mental Health (MH90027497) awarded to Golda S. Ginsburg, Ph.D. During the preparation of this manuscript, Dr. Becker was supported by the National Institute of Mental Health (T32 MH 18834). Dr. Becker is now a consultant to PracticeWise, LLC, a private behavioral health consulting firm. We are very grateful to the school-based therapists, the students, and their parents who participated in the study; the numerous research assistants and evaluators (especially Ms. Emily Becker) for their assistance in implementing this study, and to Dr. Julie Kingery, Assistant Professor at Hobart and William Smith Colleges, whose input was critical during grant preparation and early stages of this study.

Author information

Author notes

  1. Kimberly D. Becker

    Present address: Department of Mental Health, The Johns Hopkins University School of Public Health, Baltimore, MD, USA

  2. Tess K. Drazdowski

    Present address: Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA

Authors and Affiliations

  1. Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, 550 North Broadway/Suite 202, Baltimore, MD, 21205, USA

    Golda S. Ginsburg, Kimberly D. Becker & Tess K. Drazdowski

  2. Department of Psychology, Arizona State University, Tempe, AZ, USA

    Jenn-Yun Tein

Authors
  1. Golda S. Ginsburg
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kimberly D. Becker
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Tess K. Drazdowski
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jenn-Yun Tein
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Golda S. Ginsburg.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ginsburg, G.S., Becker, K.D., Drazdowski, T.K. et al. Treating Anxiety Disorders in Inner City Schools: Results from a Pilot Randomized Controlled Trial Comparing CBT and Usual Care. Child Youth Care Forum 41, 1–19 (2012). https://doi.org/10.1007/s10566-011-9156-4

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10566-011-9156-4

Keywords

Search

Navigation