Cognitive-behavioral therapy for anxiety disorders in
					children and adolescents: a systematic review of follow-up
					studies

Davis, Roberta; Souza, Maria Augusta Mansur de; Rigatti, Roberta; Heldt, Elizeth

doi:10.1590/0047-2085000000047

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Literature Reviews • J. bras. psiquiatr. 63 (4) • Oct-Dec 2014 • https://doi.org/10.1590/0047-2085000000047 copy

Cognitive-behavioral therapy for anxiety disorders in children and adolescents: a systematic review of follow-up studies

Terapia cognitivo-comportamental para transtornos de ansiedade na infância e adolescência: revisão sistemática de estudos de seguimento

Authorship SCIMAGO INSTITUTIONS RANKINGS

Objective

To conduct a systematic review about the long-term response to cognitive-behavioral therapy (CBT) for anxiety disorders (ADs) in children and adolescents.

Methods

The PubMed and ISI Web of Science databases were consulted. Search in the databases was performed in November 2012 and included cohort studies after CBT for ADs in children and adolescents with a follow-up period over 12 months.

Results

A total of 10 papers met the inclusion criteria. The follow-up period ranged from 12 months to 13 years and the results generally showed maintenance of the short-term benefits with CBT. However, the studies presented limitations, especially regarding methods, such as lack of a control group and losses to follow-up.

Conclusion

The long-term benefits of CBT were identified, however it would be interesting to conduct other studies with more frequent assessment periods, in order to minimize losses to follow-up, in addition to evaluating children and adolescents in the various stages of their development.

Cognitive-behavioral therapy; anxiety disorders in children and adolescents; follow-up studies

Studies*	Intervention		Follow-up**
Studies*	Protocol	Format	Time^# Mean (SD)	Total sample	♂	♀	Age^# Mean (SD)
Cobham et al., 2010	CBT	GCBT x GCBT+ Parents	35 and 28 months 31.85 (2.56)	60 (89.6%)	31	29	10 to 17 12.58 (1.65)
Saavedra et al., 2010	CBT	GCBT x Individual (self control) x Individual (contingency manegement)	8 to 13 years 9.83 (1.71)	67 (81%)	35	32	16 to 26 19.43 (3.02)
O’Leary; Barret; Fjermestad, 2009	FOCUS	GCBT + Parents x CBT Individual + Parents	7 years	38 (49%)	20	18	13 to 24 18.4 (2.85)
Bernstein et al., 2008	FRIENDS	GCBT x GCBT + Parents x Waiting list	1 year	51 (84%)	NI	NI	8 to 12
Kendall et al., 2004	Coping Cat	GCBT	5.5 to 9.3 years 7.4 (NI)	85 (90%)	53	32	15 to 22 19.3 (NI)
Manassis et al., 2004	Coping Bear	Psychoeducation children x GCBT + Parents	6 to 7 years	43 (68%)	14	29	14 to 19 16.5 (1.2)
Barret et al., 2001	CBT	GCBT x GCBT+ Parents	5 to 7 years 6.2 (NI)	52 (67%)	28	24	13 to 21 16.08 (2.26)
Cobham; Dadds; Spence, 1998	Coping Cat Coping Koala	GCBT x GCBT + Parents	1 year	NI	NI	NI	8 to 15
Barrett, 1998	Coping Cat Coping Koala	GCBT x GCBT + Parents	1 year	NI	NI	NI	8 to 15
Barrett; Dadds; Rapee, 1996	Coping Cat Coping Koala	GBTG x GBTG + Parents	1 year	NI	NI	NI	8 to 15

Studies*	Diagnosis	Instruments	Follow-up outcomes
Studies*	Diagnosis	Instruments	Symptoms	Diagnosis
Cobham et al., 2010	Anxiety disorder	ADIS-C CBCL RCMA-S	Anxiety − significant improvement maintained, compared to the baseline	No longer met the criteria for the Ads = 48 (80%) There was significant difference between the interventions: GCBT − 23 (69%) without a diagnosis of ADs GCBT + family − 25 (92%) without a diagnosis of ADs
Saavedra et al., 2010	Social phobia Specific phobia Panic disorder/Agoraphobia Depressive disorder	ADIS-C & ADIS-P ADIS-IV RCMA-S MAS CDI BDI CBCL YASR	Anxiety and depression symptoms − significant improvement after 1 year of follow-up, maintained up to 9 years after CBT	62 (92.5%) no longer met the criteria for the ADs 61 (91%) did not meet the criteria for depression 55 (82.1%) did not meet the criteria for any disorder
O’Leary; Barrett; Fjermestad, 2009	OCD	ADIS –C & ADIS-P NIMH-GOCS Y-BOCS-SR MASC MASC-OC BDI-II FAD DASS-21	Anxiety − no significant improvement. Depression symptoms – significant improvement in individual CBT and in older individuals	No diagnosis of OCD after 7 years of CBT (87%) Individual CBT (79%) GCBT (95%)
Bernstein et al., 2008	Separation anxiety disorder GAD Social phobia	ADIS MASC SCARED CGI	Anxiety − significant improvement when compared to control group in 6 months of follow-up, did not remain significant at 12 months	No significant difference regarding the diagnosis of ADs. CBT with training for parents appears to be more effective than CBT only with the children
Kendall et al., 2004	Primary Anxiety disorder	ADIS–C & ADIS–P ADIS-IV-L CASI RCMAS CDI CQ-C APES CBCL CQ-P STAIC	Anxiety and depression symptoms − significant improvement maintained, compared to the baseline	No longer met the criteria for the ADs: After the CBT sessions = 51.2% At follow-up = 80.5%
Manassis et al., 2004	GAD Others Anxiety Disorders	DICA-R-P RCMAS	Anxiety and depression symptoms − persisted at the follow-up, did not require clinical care in 70% of the individuals treated	No significant difference regarding the diagnosis of ADs Baseline (n = 63): GAD = 32 (52%) Other ADs = 21 (49%) Follow-up (n = 43): GAD = 31 (48%) Other ADs = 22 (51%)
Barrett et al., 2001	Separation anxiety disorder Social phobia Simple phobia Depression Oppositional defiant disorder	ADIS-C RCMAS FSSC-R CDI CBCL	Anxiety and depression symptoms − significant improvement maintained at 6-year follow up, compared to the baseline, but greater than at the 12-month evaluation	No longer met the criteria for the ADs: After 12 months = 79.6% and after 6 years = 85,7% CBT and CBT+FAM interventions were equally effective
Cobham; Dadds; Spence, 1998	GAD Social phobia Agoraphobia Overanxious disorder Separation anxiety disorder	ADIS-C & ADIS-P RCMAS STAIC CBCL	Anxiety − overall improvement observed in the four conditions of treatment and significant difference maintained, compared to the baseline	No longer met the criteria for the ADs: CBT = 82% and CBT+PAM = 80%
Barrett, 1998	Separation anxiety disorder Secondary diagnosis of simple phobia Depression	ADIS-C & ADIS-P FSSC-R CBCL	Anxiety − significant improvement maintained at follow-up	No longer met the criteria for the ADs: After CBT and CBT+FAM = 64.8% versus 25.2% waiting list After 12 months: GCBT = 64.5% versus GCBT+FAM = 84.8% The intervention that included the family proved more effective than GCBT only with the children
Barrett; Dadds; Rapee, 1996	Overanxiety disorder Separation Anxiety disorder Social phobia	ADIS-C & ADIS-P RCMAS FSSC-R CDI CBCL DASS FEAR	Anxiety and depression symptoms − overall improvement observed in the three conditions of treatment and significant difference maintained at follow-up, compared to the baseline	No longer met the criteria for the ADs: After 12 months = 70.3% of CBT versus 95.6% of CBT+FAM Both interventions maintained long-term benefits, but there were additional clinical benefits for CBT+FAM

Instituto de Psiquiatria da Universidade Federal do Rio de Janeiro Av. Venceslau Brás, 71 Fundos, 22295-140 Rio de Janeiro - RJ Brasil, Tel./Fax: (55 21) 3873-5510 - Rio de Janeiro - RJ - Brazil
E-mail: editora@ipub.ufrj.br

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[1] Address for correspondence: Roberta Davis. E-mail: betadavis@hotmail.com