CBT most effective for anxiety disorders in children and young people

University of Oxford | November 2018 | Group therapy most effective treatment for anxiety in young people

Talking therapy or group cognitive behavioural therapy (CBT) has been shown to be the most effective psychotherapy in reducing symptoms of anxiety  in children and adolescents.  University of Oxford researchers used a meta-analysis to answer the question: What is the best psychotherapeutic approach for anxiety disorders in children and adolescents in terms of efficacy and acceptability? Their study included 101 unique randomized clinical trials (approximately 7,000 participants) that compared any structured psychotherapy with another psychotherapy or a control condition for anxiety disorders in children and adolescents.

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The meta analysis found that CBT, was significantly beneficial compared with placebo or waiting list in terms of improving children’s and adolescent’s quality of life and functional improvement (Source: University of Oxford).    

The findings have now been published in JAMA Psychiatry 

Abstract
Importance  Anxiety disorders are common in children and adolescents, and uncertainty remains regarding the optimal strategy of psychotherapies in this population.

Objective  To compare and rank the different types of psychotherapies and the different ways of delivering psychological treatments for anxiety disorders in children and adolescents.

Data Sources  PubMed, Cochrane Central Register of Controlled Trials, EMBASE, PsycINFO, Web of Science, CINAHL (Cumulative Index to Nursing and Allied Health Literature), ProQuest Dissertations, LILACS (Literatura Latino Americana em Ciências da Saúde), international trial registers, and US Food and Drug Administration reports were searched from inception to November 30, 2017.

Study Selection  Randomized clinical trials that compared any structured psychotherapy with another psychotherapy or a control condition for anxiety disorders in children and adolescents were selected.

Data Extraction and Synthesis  Four researchers independently performed data extraction and quality assessment. Pairwise meta-analyses and Bayesian network meta-analysis within the random-effects model were used to synthesize data.

Main Outcomes and Measures  Efficacy (change in anxiety symptoms) posttreatment and at follow-up, acceptability (all-cause discontinuation), and quality of life and functional improvement were measured. The certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation framework.

Results  A total of 101 unique trials including 6625 unique participants compared 11 different psychotherapies with 4 specific control conditions. The certainty of evidence was rated as low or very low for most comparisons. For efficacy, most psychotherapies were significantly more effective than the wait list condition posttreatment  and at the longest follow-up. However, only group cognitive behavioral therapy (CBT) was significantly more effective than the other psychotherapies and all control conditions posttreatment. For acceptability, bibliotherapy CBT had significantly more all-cause discontinuations than some psychotherapies and control conditions (range of odds ratios, 2.48-9.32). In terms of quality of life and functional improvement, CBT (delivered in different ways) was significantly beneficial compared with psychological placebo and the wait list condition.

Conclusions and Relevance  Group CBT would be the more appropriate choice of psychotherapy for anxiety disorders in children and adolescents, based on these findings. Other types of psychotherapies and different ways of delivering psychological treatment can be alternative options. Further research is needed to explore specific anxiety disorders, disorder-specific psychotherapy, and moderators of treatment effect.

Read the paper at JAMA Psychiatry 

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Nearly six in ten CCGs missing talking therapies targets

Almost six in ten clinical commissioning groups are missing targets on access to talking therapies, according to official figures | OnMedica

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Mental health charity Mind said this morning that the “unacceptable” figures reflect years of mental health services being “woefully underfunded”, and insisted that it is vital that quality, timely services must be in place to meet increasing demand.

Mind said the new data, from NHS England’s mental health dashboard on how CCGs are performing with regard to delivering talking therapies, highlight the proportion of CCGs meeting and missing their targets. These most recent available data, which are for Q3 (October-December) 2016, showed that 120 out of 209 CCGs in England (57%) are failing to meet the target for the proportion of people in their area that should be accessing talking therapies – currently set at 15.8% of the local population who have been identified as being able to benefit from talking therapies. By 2021, this target is set to rise to 25%.

The figures also revealed that barely half (52%) of CCGs met the recovery rate target for talking therapies – 101 out of 209 CCGs missed the current recovery target, which is set at 50%.

Mind pointed out that these data specifically focus on therapies available through the Improving Access to Psychological Therapies (IAPT) programme, which is supposed to increase accessibility of talking treatments to those identified as potentially benefitting from receiving them (typically, people with common mental health problems such as depression and anxiety disorder).

Psychological Interventions for Children with Functional Somatic Symptoms

Bonvanie, I.J. et al. The Journal of Pediatrics | Published online: 14 April 2017

Objective: To analyze the effectiveness of psychological treatments on symptom load and associated disability in children with functional somatic symptoms, and to explore potential moderators of effects.

Conclusions: Psychological interventions reduce symptom load, disability, and school absence in children with functional somatic symptoms. Future research should clarify which patient and treatment characteristics modify outcomes.

Read the full abstract here

New ways to treat depression in teenagers

By Ian Michael Goodyer (University of Cambridge) for The Conversation | Published online: 6 March 2017

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Image source: Mary Lock – Flickr // CC BY-NC-ND 2.0

Around one in 20 teenagers suffers from depression. Episodes can last for several months. Unfortunately, about 50% of teenagers who have a depressive episode are at risk of falling ill again, increasing the likelihood of relationship difficulties, educational failure and poor employment prospects. It’s important that treatments have a lasting effect to reduce the risk of becoming ill a second time.

My research investigates the causes of and treatments for adolescent mental illnesses, with a particular focus on depression. One of our key projects is evaluating the importance of various psychological treatments that are effective in helping young people with depression.

Only one treatment – cognitive behavioural therapy (CBT) – is approved by the UK’s National Institute for Health and Care Excellence (NICE) for treating depression in teenagers. Unfortunately, there is a shortage of CBT therapists in the UK. This means that many young people with depression are placed on a waiting list, increasing their risk of worsening mental health.

Read the full blog post here

Group mindfulness for adolescent anxiety

Crowley, M.J. et al. Child and Adolescent Mental Health | Published online 4 March 2017

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Background: Group Mindfulness Therapy (GMT) is a program tailored for adolescents that targets anxiety with mindfulness skills including present moment awareness, mindfulness in everyday life (breathing, eating, walking), body scan, loving-kindness, and self-acceptance. Youth with anxiety may benefit from mindfulness exercises precisely because they learn to redirect their mind, and presumably their attention, away from wandering in the direction of worry and negative self-appraisals and toward greater acceptance of internal states. This open trial assessed the feasibility and initial effectiveness of GMT in a school setting.

Conclusions: We demonstrate that GMT is feasible and acceptable to adolescents presenting with anxiety as a primary concern. We provide further support for the use of a mindfulness-based intervention for anxiety reduction. The group format suggests a cost-effective way to deliver services in a school setting.

Read the full abstract here

Effective psychological and psychosocial approaches to reduce repetition of self-harm: a systematic review, meta-analysis and meta-regression

Hetrick, S.E. et al. (2016) BMJ Open.6:e011024

Objective: To examine the efficacy of psychological and psychosocial interventions for reductions in repeated self-harm.

Design: We conducted a systematic review, meta-analysis and meta-regression to examine the efficacy of psychological and psychosocial interventions to reduce repeat self-harm in adults. We included a sensitivity analysis of studies with a low risk of bias for the meta-analysis. For the meta-regression, we examined whether the type, intensity (primary analyses) and other components of intervention or methodology (secondary analyses) modified the overall intervention effect.

Data sources: A comprehensive search of MEDLINE, PsycInfo and EMBASE (from 1999 to June 2016) was performed.

Eligibility criteria for selecting studies: Randomised controlled trials of psychological and psychosocial interventions for adult self-harm patients.

Results: Forty-five trials were included with data available from 36 (7354 participants) for the primary analysis. Meta-analysis showed a significant benefit of all psychological and psychosocial interventions combined (risk ratio 0.84; 95% CI 0.74 to 0.96; number needed to treat=33); however, sensitivity analyses showed that this benefit was non-significant when restricted to a limited number of high-quality studies. Meta-regression showed that the type of intervention did not modify the treatment effects.

Conclusions: Consideration of a psychological or psychosocial intervention over and above treatment as usual is worthwhile; with the public health benefits of ensuring that this practice is widely adopted potentially worth the investment. However, the specific type and nature of the intervention that should be delivered is not yet clear. Cognitive–behavioural therapy or interventions with an interpersonal focus and targeted on the precipitants to self-harm may be the best candidates on the current evidence. Further research is required.

Read the article here

Innovations in Practice: a pilot study of interpersonal psychotherapy for depressed adolescents and their parents

Gunlicks-Stoesselm, M. & Mufson, L. Child and Adolescent Mental Health. Published online: 9 May 2016

Background: Problems in adolescents’ relationships with their parents are a significant risk factor for the development and maintenance of depression. The purpose of this pilot study was to examine the feasibility and acceptability of an adaptation of interpersonal psychotherapy for depressed adolescents (IPT-A) who were also experiencing problems in their relationships with parents. The adaptation includes greater and more structured parent involvement in the treatment (IPT-AP).

Method: Fifteen adolescents (age 12–17) who were diagnosed with depression and were also experiencing conflictual or emotionally disengaged relationships with their parents (based on adolescent or parent report on the Conflict Behavior Questionnaire) participated in a 16 week randomized clinical trial of individually delivered IPT-A versus IPT-AP. Data regarding the feasibility and acceptability of IPT-AP were collected. Assessments of depression and family functioning were completed at baseline and weeks 4, 8, 12, and 16 by evaluators blind to treatment condition.

Results: IPT-AP was feasible to implement, and adolescents and parents reported high treatment satisfaction. Adolescents demonstrated significant improvements in depressive symptoms, general functioning, and family functioning. IPT-AP was more efficacious than individual IPT-A in improving adolescents’ perceptions of father–adolescent relations and mothers’ perceptions of mother–adolescent relations.

Conclusions: Interpersonal psychotherapy for depressed adolescents and their parents was feasible to implement and acceptable to families, indicating that a full-scale randomized controlled trial to evaluate its efficacy is warranted.

Read the abstract here