Institution at which the work was performed: McMaster University.
COGNITIVE BEHAVIORAL THERAPY AGE EFFECTS IN CHILD AND ADOLESCENT ANXIETY: AN INDIVIDUAL PATIENT DATA METAANALYSIS
Version of Record online: 8 MAY 2013
© 2013 Wiley Periodicals, Inc.
Depression and Anxiety
Volume 30, Issue 9, pages 829–841, September 2013
How to Cite
Bennett, K., Manassis, K., Walter, S. D., Cheung, A., Wilansky-Traynor, P., Diaz-Granados, N., Duda, S., Rice, M., Baer, S., Barrett, P., Bodden, D., Cobham, V. E., Dadds, M. R., Flannery-Schroeder, E., Ginsburg, G., Heyne, D., Hudson, J. L., Kendall, P. C., Liber, J., Warner, C. M., Mendlowitz, S., Nauta, M. H., Rapee, R. M., Silverman, W., Siqueland, L., Spence, S. H., Utens, E. and Wood, J. J. (2013), COGNITIVE BEHAVIORAL THERAPY AGE EFFECTS IN CHILD AND ADOLESCENT ANXIETY: AN INDIVIDUAL PATIENT DATA METAANALYSIS. Depress. Anxiety, 30: 829–841. doi: 10.1002/da.22099
Contract grant sponsor: Canadian Institutes of Health Research.
Conflict of interest: Dr. Manassis reports book royalties from Routledge Publishing. Dr. Kendall reports royalties from sales of Coping CAT and related treatment materials. Remaining authors have no relevant conflicts of interest.
- Issue online: 3 SEP 2013
- Version of Record online: 8 MAY 2013
- Manuscript Accepted: 23 FEB 2013
- Manuscript Revised: 22 FEB 2013
- Manuscript Received: 31 AUG 2012
- Canadian Institutes of Health Research
- anxiety disorders;
- cognitive behavior therapy;
- empirical supported treatment
Investigations of age effects on youth anxiety outcomes in randomized trials (RCTs) of cognitive behavior therapy (CBT) have failed to yield a clear result due to inadequate statistical power and methodologic weaknesses. We conducted an individual patient data metaanalysis to address this gap.
Does age moderate CBT effect size, measured by a clinically and statistically significant interaction between age and CBT exposure?
All English language RCTs of CBT for anxiety in 6–19 year olds were identified using systematic review methods. Investigators of eligible trials were invited to submit their individual patient data. The anxiety disorder interview schedule (ADIS) primary diagnosis severity score was the primary outcome. Age effects were investigated using multilevel modeling to account for study level data clustering and random effects.
Data from 17 of 23 eligible trials were obtained (74%); 16 studies and 1,171 (78%) cases were available for the analysis. No interaction between age and CBT exposure was found in a model containing age, sex, ADIS baseline severity score, and comorbid depression diagnosis (power ≥ 80%). Sensitivity analyses, including modeling age as both a categorical and continuous variable, revealed this result was robust.
Adolescents who receive CBT in efficacy research studies show benefits comparable to younger children. However, CBT protocol modifications routinely carried out by expert trial therapists may explain these findings. Adolescent CBT protocols are needed to facilitate the transportability of efficacy research effects to usual care settings where therapists may have less opportunity for CBT training and expertise development.