Open AccessA Meta-analysis to Guide the Enhancement of CBT for Childhood Anxiety: Exposure Over Anxiety Management
Author(s) -
Stephen P. Whiteside,
Leslie Sim,
Allison S. Morrow,
Wigdan Farah,
Daniel R. Hilliker,
M. Hassan Murad,
Zhen Wang
Publication year - 2019
Publication title -
clinical child and family psychology review
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.109
H-Index - 101
eISSN - 1573-2827
pISSN - 1096-4037
DOI - 10.1007/s10567-019-00303-2
Subject(s) - anxiety , meta analysis , psychology , cognitive behavioral therapy , clinical psychology , psychological intervention , separation anxiety disorder , exposure therapy , relaxation (psychology) , specific phobia , cognitive therapy , anxiety disorder , cognitive restructuring , cognition , psychotherapist , psychiatry , medicine , social psychology
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.