Group Cognitive Behavioral Therapy and Attention Bias Modification for Childhood Anxiety Disorders: A Factorial Randomized Trial of Efficacy.

ABSTRACT: BACKGROUND:The objective of this study is to assess group differences in symptom reduction between individuals receiving group cognitive behavioral therapy (G-CBT) and attention bias modification (ABM) compared to their respective control interventions, control therapy (CT), and attention control training (ACT), in a 2?×?2 factorial design. METHODS:A total of 310 treatment-naive children (7-11 years of age) were assessed for eligibility and 79 children with generalized, separation or social anxiety disorder were randomized and received G-CBT (n?=?42) or CT (n?=?37). Within each psychotherapy group, participants were again randomized to ABM (n?=?38) or ACT (n?=?41) in a 2?×?2 factorial design resulting in four groups: G-CBT + ABM (n?=?21), G-CBT + ACT (n?=?21), CT + ABM (n?=?17), and CT + ACT (n?=?20). Primary outcomes were responder designation as defined by Clinical Global Impression-Improvement (CGI-I) scale (?2) and change on the Pediatric Anxiety Rating Scale (PARS). RESULTS:There were significant improvements of symptoms in all groups. No differences in response rates or mean differences in PARS scores were found among groups: G-CBT + ABM group (23.8% response; 3.9 points, 95% confidence interval [CI] -0.3 to 8.1), G-CBT + ACT (42.9% response; 5.6 points, 95% CI 2.2-9.0), CT + ABM (47.1% response; 4.8 points 95% CI 1.08-8.57), and CT + ACT (30% response; 0.8 points, 95% CI -3.0 to 4.7). No evidence or synergic or antagonistic effects were found, but the combination of G-CBT and ABM was found to increase dropout rate. CONCLUSIONS:We found no effect of G-CBT or ABM beyond the effects of comparison groups. Results reveal no benefit from combining G-CBT and ABM for anxiety disorders in children and suggest potential deleterious effects of the combination on treatment acceptability.

SUBMITTER: Salum GA 

PROVIDER: S-EPMC6421990 | biostudies-literature | 2018 Nov

REPOSITORIES: biostudies-literature