Volume 49, Issue 10 , Pages 1043-1052, October 2010
Does Cognitive Behavioral Therapy for Youth Anxiety Outperform Usual Care in Community Clinics? An Initial Effectiveness Test
Objective
Most tests of cognitive behavioral therapy (CBT) for youth anxiety disorders have shown beneficial effects, but these have been efficacy trials with recruited youths treated by researcher-employed therapists. One previous (nonrandomized) trial in community clinics found that CBT did not outperform usual care (UC). The present study used a more stringent effectiveness design to test CBT versus UC in youths referred to community clinics, with all treatment provided by therapists employed in the clinics.
Method
A randomized controlled trial methodology was used. Therapists were randomized to training and supervision in the Coping Cat CBT program or UC. Forty-eight youths (56% girls, 8 to 15 years of age, 38% Caucasian, 33% Latino, 15% African-American) diagnosed with DSM-IV anxiety disorders were randomized to CBT or UC.
Results
At the end of treatment more than half the youths no longer met criteria for their primary anxiety disorder, but the groups did not differ significantly on symptom (e.g., parent report, eta-square = 0.0001; child report, eta-square = 0.09; both differences favoring UC) or diagnostic (CBT, 66.7% without primary diagnosis; UC, 73.7%; odds ratio 0.71) outcomes. No differences were found with regard to outcomes of comorbid conditions, treatment duration, or costs. However, youths receiving CBT used fewer additional services than UC youths (χ21 = 8.82, p = .006).
Conclusions
CBT did not produce better clinical outcomes than usual community clinic care. This initial test involved a relatively modest sample size; more research is needed to clarify whether there are conditions under which CBT can produce better clinical outcomes than usual clinical care.
Clinical trial registry information—Community Clinic Test of Youth Anxiety and Depression Study, URL: http://clinicaltrials.gov, unique identifier: NCT01005836.
Key Words: child and adolescent anxiety disorders, effectiveness research, cognitive behavioral therapy
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The study was supported by grant R01-MH574347 from the NIMH to Dr. Weisz.
We thank Philip C. Kendall (Temple University) and Donna K. McClish (Virginia Commonwealth University) for their consultation on the project. We also thank our clinic partners for their help, in many forms, throughout the study. These include Herb Blaufarb, Susan Hall-Marley, and Terry Rattray (Child and Family Guidance Center); Kita Curry, Cynthia Kelly, and Marian Williams (Didi Hirsch Community Mental Health Center); Anita Feltes (Edelman Westside Mental Health); Jill Morgan and David Slay (Greater Long Beach Child Guidance Center); Joseph Ho, Philip Pannell, and Robert Parsons (Pacific Clinics); and Thomas Ciesla, Carol Falender, Allison Pinto, and Rebecca Refuerzo (St. John's Health Center). We also thank the therapists, parents, and youths who participated in the study, and our project administrative and graduate student colleagues, including Amie Bettencourt, C. Ashley Borders, Jen Durham-Fowler, Aileen Echiverri, Samantha Fordwood, Sarah Francis, Andrea Kasimian, May Lim, Tamara Sharpe, Irina Tauber, and Alanna Updegraff (University of California–Los Angeles); Kristin Hawley (University of Missouri); Amanda Jensen-Doss (University of Miami); David Langer (Judge Baker Children's Center); Antonio Polo (DePaul University); and V. Robin Weersing (San Diego State University).
Disclosure: Dr. Southam-Gerow and Dr. McLeod receive financial support from the NIMH. Dr. Weisz receives financial support from the NIMH, the Norlien Foundation, and the John D. and Catherine T. MacArthur Foundation. Drs. Chu, Gordis, and Connor-Smith report no biomedical financial interests or potential conflicts of interest.
PII: S0890-8567(10)00494-6
doi:10.1016/j.jaac.2010.06.009
© 2010 American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.
Volume 49, Issue 10 , Pages 1043-1052, October 2010
