Brief, intensive and concentrated CBT for anxiety disorders in children

This review aims to evaluate brief, intensive and concentrated (BIC) cognitive behavioural therapy, adapted from “standard” CBT treatments for anxiety disorders in young people | Simon Brett for the Mental Elf

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Image source: Samantha Cimino – Flickr // CC BY-NC 2.0

Anxiety disorders affect 10% of children and 20% of adolescents at any one time. These disorders frequently persist into adulthood and are often associated with significant difficulties across the life span (e.g., major depression, substance abuse) (Woodward & Fergusson, 2001).

However, despite the existence of evidence-based interventions, the majority of young people do not access treatment. Young people face substantial barriers to seeking and receiving treatment; stigma, infrequent contact with health services, waiting times, lack of knowledge about mental health and few sufficiently trained mental health professionals.

Given the sound underlying therapeutic principles and evidence-base of CBT, it appears to be an ideal therapy to adapt and develop brief, intensive and concentrated (BIC) approaches designed to reach more young people, be more efficient and more cost-effective.

 

 

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Cognitive behavioral and mindfulness-based group sleep improvement intervention for at-risk adolescents

Blake, M. et al. Sleep | Published online: 18 April 2017

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Objective: The aim of this study was to test whether a cognitive-behavioral and mindfulness-based sleep intervention could improve sleep and anxiety on school nights in a group of at-risk adolescents. We also examined whether benefits to sleep and anxiety would be mediated by improvements in sleep hygiene awareness and pre-sleep hyperarousal.

Conclusion: This study provides evidence that pre-sleep arousal but not sleep hygiene awareness is important for adolescents’ perceived sleep quality, and could be a target for new treatments of adolescent sleep problems.

Read the abstract here

Initial severity of depression and efficacy of cognitive–behavioural therapy

Furukawa, T. A. et al. The British Journal of Psychiatry. Published online: 19 January 2017

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Image source: Jasmine Parker – Wellcome Images // CC BY-NC-ND 4.0

Background: The influence of baseline severity has been examined for antidepressant medications but has not been studied properly for cognitive–behavioural therapy (CBT) in comparison with pill placebo.

 

Conclusions: Patients suffering from major depression can expect as much benefit from CBT across the wide range of baseline severity. This finding can help inform individualised treatment decisions by patients and their clinicians.

Read the full abstract here

Depression – Drugs vs CBT

Primary Care Corner with Geoffrey Modest MD. BMJ Evidence-Based Medicine Blog

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Image source: Rowena Dugdale – Wellcome Images // CC BY-NC-ND 4.0

The Agency for Healthcare Research and Quality (AHRQ) just released their clinical review comparing nonpharmacological vs pharmacological treatments for patients with major depressive disorders

Details:

  • They reviewed 44 trials from 1990-2015 of patients with mild to severe major depressive disorder (MDD)
  • Cognitive behavioral therapy (CBT) is as effective as second-generation antidepressants (SGAs, which for this review includes SSRIs, SNRIs, bupropion, mirtazapine, nefazodone, and trazodone) for mild to severe MDD, with moderate level of evidence. The evidence does not support SGAs plus CBT as being better than SGAs alone, though this was based on low quality of evidence
  • Therapy (SGA vs CBT) was discontinued at equal rates, for either SGAs or CBT, for adverse effects or patient dissatisfaction

Read the full blog post here

Read the full review here

Tele-Mental Health for Children: Using Videoconferencing for Cognitive Behavioral Therapy (CBT)

Goldschmidt, K. Journal of Pediatric Nursing. Published online: October 7, 2016

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Mental health disorders occur in 4% of children and 10 to 20% of adolescents and are linked with “depression, anxiety, risky behaviors, poor physical health, obesity, substance abuse and suicide” (Garber, Frankel, & Herrington, 2016, p. 181). Adolescents diagnosed with a depressive disorder have high rates of recurrence: 25% within one year, 40% within two years, and 70% within five years (Mash & Wolfe, 2012). It is imperative for mental health specialist to reach children with mental health disorders early in their development in an effort to decrease morbidity and mortality; however, access to mental health care, especially for children, is limited (Lauckner & Whitten, 2015).

Read the abstract here

Anxiety disorders in children and adolescents

Hill, C. et al. Paediatrics and Child Health. Published online: September 10, 2016

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Anxiety disorders are among the most common psychiatric disorders in children and adolescents. They commonly interfere with peer relationships, schooling and family life, and persist into adulthood if left untreated.

This paper gives an overview of the identification, assessment and treatment of anxiety disorders in children and young people. Identification of anxiety disorders is often poor and many young people with anxiety disorders go untreated. We present a brief review of the evidence base for pharmacological and psychological treatment approaches to the management of anxiety disorders in youth. Both have been found to be effective in the treatment of anxiety disorders, although psychological treatments such as Cognitive Behavioural Therapy (CBT) are considered the first-line treatment due to relative benefits in terms of patient safety and parental preference. Low intensity CBT approaches such as bibliotherapy and online therapies are effective and have the potential to improve access to evidence-based interventions. CBT approaches have also been found to be effective with particular patient groups, such as those with long-term physical health conditions and autism spectrum disorders, who are at an increased risk of anxiety disorders.

Read the abstract here