Cognitive Behavioral Therapy Age Effects in Child and Adolescent Anxiety: An Individual Patient Data Metaanalysis
Author(s)
Bennett, Kathryn
Manassis, Katharina
Walter, Stephen D
Cheung, Amy
Wilansky-Traynor, Pamela
Diaz-Granados, Natalia
Duda, Stephanie
Rice, Maureen
Baer, Susan
Barrett, Paula
Bodden, Denise
Cobham, Vanessa E
Dadds, Mark R
Flannery-Schroeder, Ellen
Ginsburg, Golda
Heyne, David
Hudson, Jennifer L
Kendall, Philip C
Liber, Juliette
Warner, Carrie Masia
Mendlowitz, Sandra
Nauta, Maaike H
Rapee, Ronald M
Silverman, Wendy
Siqueland, Lynne
Spence, Susan H
Utens, Elisabeth
Wood, Jeffrey J
Griffith University Author(s)
Year published
2013
Metadata
Show full item recordAbstract
Investigations of age effects on youth anxiety outcomes in randomized trials (RCTs) of cognitive behavior therapy (CBT) have failed to yield a clear result due to inadequate statistical power and methodologic weaknesses. We conducted an individual patient data metaanalysis to address this gap. Question: Does age moderate CBT effect size, measured by a clinically and statisticallysigni?cant interaction between age and CBT exposure? Methods: All English language RCTs of CBT for anxiety in 6-19 year olds were identi?ed using systematic review methods. Investigators of eligible trials were invited to submit their individual ...
View more >Investigations of age effects on youth anxiety outcomes in randomized trials (RCTs) of cognitive behavior therapy (CBT) have failed to yield a clear result due to inadequate statistical power and methodologic weaknesses. We conducted an individual patient data metaanalysis to address this gap. Question: Does age moderate CBT effect size, measured by a clinically and statisticallysigni?cant interaction between age and CBT exposure? Methods: All English language RCTs of CBT for anxiety in 6-19 year olds were identi?ed using systematic review methods. Investigators of eligible trials were invited to submit their individual patient data. The anxiety disorder interview schedule (ADIS) primary diagnosis severity score was the primary outcome. Age effects were investigated using multilevel modeling to account for study level data clustering and random effects. Results: Data from 17 of 23 eligible trials were obtained (74%); 16 studies and 1,171 (78%) cases were available for the analysis. No interaction between age and CBT exposure was found in a model containing age, sex, ADIS baseline severity score, and comorbid depression diagnosis (power = 80%). Sensitivity analyses, including modeling age as both a categorical and continuous variable, revealed this result was robust. Conclusions: Adolescents who receive CBT in ef?cacy research studies show bene?ts comparable to younger children. However, CBT protocol modi?cations routinely carried out by expert trial therapists may explain these ?ndings. Adolescent CBT protocols are needed to facilitate the transportability of ef?cacy research effects to usual care settings where therapists may have less opportunity for CBT training and expertise development. Depression and Anxiety 00:1-13, 2013.
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View more >Investigations of age effects on youth anxiety outcomes in randomized trials (RCTs) of cognitive behavior therapy (CBT) have failed to yield a clear result due to inadequate statistical power and methodologic weaknesses. We conducted an individual patient data metaanalysis to address this gap. Question: Does age moderate CBT effect size, measured by a clinically and statisticallysigni?cant interaction between age and CBT exposure? Methods: All English language RCTs of CBT for anxiety in 6-19 year olds were identi?ed using systematic review methods. Investigators of eligible trials were invited to submit their individual patient data. The anxiety disorder interview schedule (ADIS) primary diagnosis severity score was the primary outcome. Age effects were investigated using multilevel modeling to account for study level data clustering and random effects. Results: Data from 17 of 23 eligible trials were obtained (74%); 16 studies and 1,171 (78%) cases were available for the analysis. No interaction between age and CBT exposure was found in a model containing age, sex, ADIS baseline severity score, and comorbid depression diagnosis (power = 80%). Sensitivity analyses, including modeling age as both a categorical and continuous variable, revealed this result was robust. Conclusions: Adolescents who receive CBT in ef?cacy research studies show bene?ts comparable to younger children. However, CBT protocol modi?cations routinely carried out by expert trial therapists may explain these ?ndings. Adolescent CBT protocols are needed to facilitate the transportability of ef?cacy research effects to usual care settings where therapists may have less opportunity for CBT training and expertise development. Depression and Anxiety 00:1-13, 2013.
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Journal Title
Depression and Anxiety
Volume
30
Issue
9
Subject
Clinical sciences