Abstract
Methods to deliver empirically validated treatments for anxious youth that require fewer therapist resources (low intensity) are beginning to emerge. However, the relative efficacy of low-intensity treatment for youth anxiety against standard face-to-face delivery has not been comprehensively evaluated. Young people aged 6–16 years with a primary anxiety disorder (N = 281) were randomly allocated to treatment delivered either face-to-face or in a low-intensity format. Face-to-face treatment comprised ten, 60-min sessions delivered by a qualified therapist. Low intensity comprised information delivered in either printed (to parents of children under 13) or electronic (to adolescents aged 13 +) format and was supported by up to four telephone sessions with a minimally qualified therapist. Youth receiving face-to-face treatment were significantly more likely to remit from all anxiety disorders (66%) than youth receiving low intensity (49%). This difference was reflected in parents’ (but not child) reports of child’s anxiety symptoms and life interference. No significant moderators were identified. Low intensity delivery utilised significantly less total therapist time (175 min) than face-to-face delivery (897 min) and this was reflected in a large mean difference in therapy costs ($A735). Standard, face-to-face treatment for anxious youth is associated with significantly better outcomes than delivery of similar content using low-intensity methods. However, the size of this difference was relatively small. In contrast, low-intensity delivery requires markedly less time from therapists and subsequently lower treatment cost. Data provide valuable information for youth anxiety services.
Clinical trial registration information: A randomised controlled trial of standard care versus stepped care for children and adolescents with anxiety disorders; https://anzctr.org.au/; ACTRN12612000351819.
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Notes
Based on Australian Medical Benefits Schedule, 2015/2016.
In fact, the same pattern of results was shown across all dependent variables.
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Acknowledgements
The research was supported by National Health and Medical Research Council grant APP1027556. The authors would like to thank the research staff and therapists who worked on this project. Particular thanks are expressed to Annabel Price, DPT, and Kathryn Preece, MCP, of the Department of Psychology, Macquarie University for management of the trial.
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Drs Rapee, Lyneham, Wuthrich, & Hudson are authors of the Cool Kids program that is used in this research but receive no royalties. Drs Rapee and Lyneham are authors of the book “Helping your anxious child” that is used in the parent self-help arm and receive royalties.
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Rapee, R.M., Lyneham, H.J., Wuthrich, V. et al. Low intensity treatment for clinically anxious youth: a randomised controlled comparison against face-to-face intervention. Eur Child Adolesc Psychiatry 30, 1071–1079 (2021). https://doi.org/10.1007/s00787-020-01596-3
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DOI: https://doi.org/10.1007/s00787-020-01596-3