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

  • Stephen P. H. WhitesideEmail author
  • Leslie A. Sim
  • Allison S. Morrow
  • Wigdan H. Farah
  • Daniel R. Hilliker
  • M. Hassan Murad
  • Zhen Wang
Article

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.

Keywords

Childhood anxiety disorders Cognitive behavior therapy Exposure therapy Literature review Relaxation 

Notes

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).

Compliance with Ethical Standards

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.

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© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Psychiatry and PsychologyMayo ClinicRochesterUSA
  2. 2.Robert D. and Patricia E. Kern Center for Science of Health Care DeliveryMayo ClinicRochesterUSA

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