Brief Behavioral Therapy for Pediatric Anxiety and Depression in Primary Care: A Randomized Clinical Trial
Open accessAbstract
Importance: Anxiety and depression affect 30% of youth but are markedly undertreated compared with other mental disorders, especially in Hispanic populations. Objective: To examine whether a pediatrics-based behavioral intervention targeting anxiety and depression improves clinical outcome compared with referral to outpatient community mental health care. Design, Setting, and Participants: This 2-center randomized clinical trial with masked outcome assessment conducted between brief behavioral therapy (BBT) and assisted referral to care (ARC) studied 185 youths (aged 8.0-16.9 years) from 9 pediatric clinics in San Diego, California, and Pittsburgh, Pennsylvania, recruited from October 6, 2010, through December 5, 2014. Youths who met DSM-IV criteria for full or probable diagnoses of separation anxiety disorder, generalized anxiety disorder, social phobia, major depression, dysthymic disorder, and/or minor depression; lived with a consenting legal guardian for at least 6 months; and spoke English were included in the study. Exclusions included receipt of alternate treatment for anxiety or depression, presence of a suicidal plan, bipolar disorder, psychosis, posttraumatic stress disorder, substance dependence, current abuse, intellectual disability, or unstable serious physical illness. Interventions: The BBT consisted of 8 to 12 weekly 45-minute sessions of behavioral therapy delivered in pediatric clinics by master's-level clinicians. The ARC families received personalized referrals to mental health care and check-in calls to support accessing care from master's-level coordinators. Main Outcomes and Measures: The primary outcome was clinically significant improvement on the Clinical Global Impression-Improvement scale (score ≤2). Secondary outcomes included the Pediatric Anxiety Rating Scale, Children's Depression Rating Scale-Revised, and functioning. Results: A total of 185 patients were enrolled in the study (mean [SD] age, 11.3 [2.6] years; 107 [57.8%] female; 144 [77.8%] white; and 38 [20.7%] Hispanic). Youths in the BBT group (n = 95), compared with those in the ARC group (n = 90), had significantly higher rates of clinical improvement (56.8% vs 28.2%; χ21 = 13.09, P < .001; number needed to treat, 4), greater reductions in symptoms (F2,146 = 5.72; P = .004; Cohen f = 0.28), and better functioning (mean [SD], 68.5 [10.7] vs 61.9 [11.9]; t156 = 3.64; P < .001; Cohen d = 0.58). Ethnicity moderated outcomes, with Hispanic youth having substantially stronger response to BBT (76.5%) than ARC (7.1%) (χ21 = 14.90; P < .001; number needed to treat, 2). Effects were robust across sites. Conclusions and Relevance: A pediatric-based brief behavioral intervention for anxiety and depression is associated with benefits superior to those of assisted referral to outpatient mental health care. Effects were especially strong for Hispanic participants, suggesting that the protocol may be a useful tool in addressing ethnic disparities in care. Trial Registration: clinicaltrials.gov Identifier: NCT01147614.
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Approaching feared situations without safety behaviors has shown promise in previous clinical trials and has been suggested as a way of creating more robust treatment outcomes for CBT for children and adolescents.
“Approaching feared situations without safety behaviors has shown promise in previous clinical trials (e.g., Weersing et al., 2017) and has been suggested as a way of creating more robust treatment outcomes for CBT for children and adolescents (McGuire & Storch, 2018).”
From Intolerance of Uncertainty–Focused Treatment for Adolescents With Excessive Worry: A Pilot Feasibility Study (2020) · cites this paper as Weersing et al., 2017
The BBT Intervention section describes exposure as graded engagement in avoided activities, and the Discussion reports promising outcomes for the youth trial. Our copy does not say participants approached feared situations without safety behaviors, so the trial does not establish that specific element of the cited claim. The later suggestion about more robust CBT outcomes is attributed to McGuire and Storch, not Weersing et al. (LLM, conf=0.85)
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- Authors
- Weersing, V. R., Brent, D. A., Rozenman, M. S., Gonzalez, A., Jeffreys, M., Dickerson, J. F., Lynch, F. L., Porta, G., & Iyengar, S.
- Affiliations
- San Diego State University (US)
- University of Pittsburgh (US)
- University of California, Los Angeles (US)
- Department of Psychology, California State University, Long Beach
- Kaiser Permanente (US)
- Corresponding author
- Weersing, V. Robin
- ORCID
- Venue
- JAMA Psychiatry
- Publisher
- American Medical Association (AMA)
- Published
- 2017-06-01
- Volume
- 74
- Issue
- 6
- Pages
- 571
- ISSN
- 2168-622X (ISSN-L)
- PMC
- PMC5539834
- OpenAlex
- W2607380814
- Cited by
- 139
- References
- 52
- Citations by year
- 2026: 16 · 2025: 7 · 2024: 15 · 2023: 10 · 2022: 10 · 2021: 36 · 2020: 15 · 2019: 16 · 2018: 9 · 2017: 5
- FWCI
- 15.26
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- JAMA Psychiatry (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (UL1TR000124, UL1TR001881)
- National Institute of Mental Health (R01MH084935, R01MH084916)
- National Center for Advancing Translational Sciences
- Topics
- Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Keywords
- childhood anxiety, childhood depression, primary care mental health, community mental health services, separation anxiety disorder, generalized anxiety disorder, social anxiety disorder, major depressive disorder, Latino youth, underserved populations, access to mental health care, symptom relief, functional improvement, child and adolescent psychiatry
- MeSH terms
- Adolescent, Anxiety Disorders, Behavior Therapy, California, Child, Depressive Disorder, Female, Follow-Up Studies, Humans, Male, Psychiatric Status Rating Scales, Psychometrics, Psychotherapy, Brief, Referral and Consultation
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