Cognitive behavioral therapy age effects in child and adolescent anxiety

An individual patient data metaanalysis

Kathryn Bennett, Katharina Manassis, Stephen D. Walter, Amy Cheung, Pamela Wilansky-Traynor, Natalia Diaz-Granados, Stephanie Duda, Maureen Rice, Susan Baer, Paula Barrett, Denise Bodden, Vanessa E. Cobham, Mark R. Dadds, Ellen Flannery-Schroeder, Golda Ginsburg, David Heyne, Jennifer L. Hudson, Philip C. Kendall, Juliette Liber, Carrie Masia & 8 others Sandra Mendlowitz, Maaike H. Nauta, Ronald M. Rapee, Wendy Silverman, Lynne Siqueland, Susan H. Spence, Elisabeth Utens, Jeffrey J. Wood

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Background 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 statistically significant interaction between age and CBT exposure? Methods All English language RCTs of CBT for anxiety in 6-19 year olds were identified 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 efficacy research studies show benefits comparable to younger children. However, CBT protocol modifications routinely carried out by expert trial therapists may explain these findings. Adolescent CBT protocols are needed to facilitate the transportability of efficacy research effects to usual care settings where therapists may have less opportunity for CBT training and expertise development.

Original languageEnglish
Pages (from-to)829-841
Number of pages13
JournalDepression and Anxiety
Volume30
Issue number9
DOIs
StatePublished - 1 Sep 2013

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Cognitive Therapy
Anxiety
Anxiety Disorders
Appointments and Schedules
Physiological Sexual Dysfunctions
Interviews
Adolescent Behavior
Research
Cluster Analysis
Language
Research Personnel
Depression

Keywords

  • anxiety disorders
  • child/adolescent
  • cognitive behavior therapy
  • empirical supported treatment
  • treatment

Cite this

Bennett, K., Manassis, K., Walter, S. D., Cheung, A., Wilansky-Traynor, P., Diaz-Granados, N., ... Wood, J. J. (2013). Cognitive behavioral therapy age effects in child and adolescent anxiety: An individual patient data metaanalysis. Depression and Anxiety, 30(9), 829-841. https://doi.org/10.1002/da.22099
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 ; Masia, Carrie ; Mendlowitz, Sandra ; Nauta, Maaike H. ; Rapee, Ronald M. ; Silverman, Wendy ; Siqueland, Lynne ; Spence, Susan H. ; Utens, Elisabeth ; Wood, Jeffrey J. / Cognitive behavioral therapy age effects in child and adolescent anxiety : An individual patient data metaanalysis. In: Depression and Anxiety. 2013 ; Vol. 30, No. 9. pp. 829-841.
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title = "Cognitive behavioral therapy age effects in child and adolescent anxiety: An individual patient data metaanalysis",
abstract = "Background 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 statistically significant interaction between age and CBT exposure? Methods All English language RCTs of CBT for anxiety in 6-19 year olds were identified 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 efficacy research studies show benefits comparable to younger children. However, CBT protocol modifications routinely carried out by expert trial therapists may explain these findings. Adolescent CBT protocols are needed to facilitate the transportability of efficacy research effects to usual care settings where therapists may have less opportunity for CBT training and expertise development.",
keywords = "anxiety disorders, child/adolescent, cognitive behavior therapy, empirical supported treatment, treatment",
author = "Kathryn Bennett and Katharina Manassis and Walter, {Stephen D.} and Amy Cheung and Pamela Wilansky-Traynor and Natalia Diaz-Granados and Stephanie Duda and Maureen Rice and Susan Baer and Paula Barrett and Denise Bodden and Cobham, {Vanessa E.} and Dadds, {Mark R.} and Ellen Flannery-Schroeder and Golda Ginsburg and David Heyne and Hudson, {Jennifer L.} and Kendall, {Philip C.} and Juliette Liber and Carrie Masia and Sandra Mendlowitz and Nauta, {Maaike H.} and Rapee, {Ronald M.} and Wendy Silverman and Lynne Siqueland and Spence, {Susan H.} and Elisabeth Utens and Wood, {Jeffrey J.}",
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Bennett, K, Manassis, K, Walter, SD, Cheung, A, Wilansky-Traynor, P, Diaz-Granados, N, Duda, S, Rice, M, Baer, S, Barrett, P, Bodden, D, Cobham, VE, Dadds, MR, Flannery-Schroeder, E, Ginsburg, G, Heyne, D, Hudson, JL, Kendall, PC, Liber, J, Masia, C, Mendlowitz, S, Nauta, MH, Rapee, RM, Silverman, W, Siqueland, L, Spence, SH, Utens, E & Wood, JJ 2013, 'Cognitive behavioral therapy age effects in child and adolescent anxiety: An individual patient data metaanalysis', Depression and Anxiety, vol. 30, no. 9, pp. 829-841. https://doi.org/10.1002/da.22099

Cognitive behavioral therapy age effects in child and adolescent anxiety : An individual patient data metaanalysis. / 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; Masia, Carrie; Mendlowitz, Sandra; Nauta, Maaike H.; Rapee, Ronald M.; Silverman, Wendy; Siqueland, Lynne; Spence, Susan H.; Utens, Elisabeth; Wood, Jeffrey J.

In: Depression and Anxiety, Vol. 30, No. 9, 01.09.2013, p. 829-841.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Cognitive behavioral therapy age effects in child and adolescent anxiety

T2 - An individual patient data metaanalysis

AU - Bennett, Kathryn

AU - Manassis, Katharina

AU - Walter, Stephen D.

AU - Cheung, Amy

AU - Wilansky-Traynor, Pamela

AU - Diaz-Granados, Natalia

AU - Duda, Stephanie

AU - Rice, Maureen

AU - Baer, Susan

AU - Barrett, Paula

AU - Bodden, Denise

AU - Cobham, Vanessa E.

AU - Dadds, Mark R.

AU - Flannery-Schroeder, Ellen

AU - Ginsburg, Golda

AU - Heyne, David

AU - Hudson, Jennifer L.

AU - Kendall, Philip C.

AU - Liber, Juliette

AU - Masia, Carrie

AU - Mendlowitz, Sandra

AU - Nauta, Maaike H.

AU - Rapee, Ronald M.

AU - Silverman, Wendy

AU - Siqueland, Lynne

AU - Spence, Susan H.

AU - Utens, Elisabeth

AU - Wood, Jeffrey J.

PY - 2013/9/1

Y1 - 2013/9/1

N2 - Background 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 statistically significant interaction between age and CBT exposure? Methods All English language RCTs of CBT for anxiety in 6-19 year olds were identified 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 efficacy research studies show benefits comparable to younger children. However, CBT protocol modifications routinely carried out by expert trial therapists may explain these findings. Adolescent CBT protocols are needed to facilitate the transportability of efficacy research effects to usual care settings where therapists may have less opportunity for CBT training and expertise development.

AB - Background 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 statistically significant interaction between age and CBT exposure? Methods All English language RCTs of CBT for anxiety in 6-19 year olds were identified 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 efficacy research studies show benefits comparable to younger children. However, CBT protocol modifications routinely carried out by expert trial therapists may explain these findings. Adolescent CBT protocols are needed to facilitate the transportability of efficacy research effects to usual care settings where therapists may have less opportunity for CBT training and expertise development.

KW - anxiety disorders

KW - child/adolescent

KW - cognitive behavior therapy

KW - empirical supported treatment

KW - treatment

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U2 - 10.1002/da.22099

DO - 10.1002/da.22099

M3 - Article

VL - 30

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SN - 1091-4269

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Bennett K, Manassis K, Walter SD, Cheung A, Wilansky-Traynor P, Diaz-Granados N et al. Cognitive behavioral therapy age effects in child and adolescent anxiety: An individual patient data metaanalysis. Depression and Anxiety. 2013 Sep 1;30(9):829-841. https://doi.org/10.1002/da.22099