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Cited by 876Anxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesChild and Adolescent Psychosocial and Emotional DevelopmentPsychological Treatments and Assessments

Cognitive behavioural therapy for anxiety disorders in children and adolescents

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James, Anthony C, James, Georgina, Cowdrey, Felicity A, Soler, Angela, Choke, Aislinn·2015·Cochrane Database of Systematic Reviews
DOI 10.1002/14651858.cd004690.pub4PMC PMC6491167
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Abstract

BACKGROUND: A previous Cochrane review (James 2005) showed that cognitive behavioural therapy (CBT) was effective in treating childhood anxiety disorders; however, questions remain regarding (1) the relative efficacy of CBT versus non-CBT active treatments; (2) the relative efficacy of CBT versus medication and the combination of CBT and medication versus placebo; and (3) the long-term effects of CBT. OBJECTIVES: To examine (1) whether CBT is an effective treatment for childhood and adolescent anxiety disorders in comparison with (a) wait-list controls; (b) active non-CBT treatments (i.e. psychological placebo, bibliotherapy and treatment as usual (TAU)); and (c) medication and the combination of medication and CBT versus placebo; and (2) the long-term effects of CBT. SEARCH METHODS: Searches for this review included the Cochrane Central Register of Controlled Trials (CENTRAL) and the Cochrane Depression, Anxiety and Neurosis Group Register, which consists of relevant randomised controlled trials from the bibliographic databases－The Cochrane Library (1970 to July 2012), EMBASE, (1970 to July 2012) MEDLINE (1970 to July 2012) and PsycINFO (1970 to July 2012). SELECTION CRITERIA: All randomised controlled trials (RCTs) of CBT versus waiting list, active control conditions, TAU or medication were reviewed. All participants must have met the criteria of the Diagnostic and Statistical Manual (DSM) or the International Classification of Diseases (ICD) for an anxiety diagnosis, excluding simple phobia, obsessive-compulsive disorder, post-traumatic stress disorder and elective mutism. DATA COLLECTION AND ANALYSIS: The methodological quality of included trials was assessed by three reviewers independently. For the dichotomous outcome of remission of anxiety diagnosis, the odds ratio (OR) with 95% confidence interval (CI) based on the random-effects model, with pooling of data via the inverse variance method of weighting, was used. Significance was set at P < 0.05. Continuous data on each child's anxiety symptoms were pooled using the standardised mean difference (SMD). MAIN RESULTS: Forty-one studies consisting of 1806 participants were included in the analyses. The studies involved children and adolescents with anxiety of mild to moderate severity in university and community clinics and school settings. For the primary outcome of remission of any anxiety diagnosis for CBT versus waiting list controls, intention-to-treat (ITT) analyses with 26 studies and 1350 participants showed an OR of 7.85 (95% CI 5.31 to 11.60, Z = 10.26, P < 0.0001), but with evidence of moderate heterogeneity (P = 0.04, I² = 33%). The number needed to treat (NNT) was 6.0 (95% CI 7.5 to 4.6). No difference in outcome was noted between individual, group and family/parental formats. ITT analyses revealed that CBT was no more effective than non-CBT active control treatments (six studies, 426 participants) or TAU in reducing anxiety diagnoses (two studies, 88 participants). The few controlled follow-up studies (n = 4) indicate that treatment gains in the remission of anxiety diagnosis are not statistically significant. AUTHORS' CONCLUSIONS: Cognitive behavioural therapy is an effective treatment for childhood and adolescent anxiety disorders; however, the evidence suggesting that CBT is more effective than active controls or TAU or medication at follow-up, is limited and inconclusive.

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  • Studies have demonstrated better results using CBT techniques compared to other kinds of behaviour management regardless of methodology.

    “Studies have also demonstrated better results using CBT techniques compared to other kinds of behaviour management regardless of methodology 8,25-27 .”

    From Cognitive behaviour therapy for anxious paediatric dental patients: a systematic review. (2018) · cites this paper as [25]

    The Discussion (Summary of main results) finds CBT superior to waiting-list controls but explicitly says superiority over active controls, including other supportive interventions and treatment as usual, was not confirmed. The Demographics and clinical characteristics section likewise describes the evidence against active controls or treatment as usual as negative, contrary to the claim of better results regardless of methodology. (LLM, conf=0.89)

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  • Teaching cognitive behavioral techniques to encourage healthier patterns of thinking and behavior decreases symptoms of anxiety and depression.

    “Teaching cognitive behavioral techniques to encourage healthier patterns of thinking and behavior decreases symptoms of anxiety and depression (James et al., 2015, Weisz et al., 2006).”

    From A pilot evaluation of the SPARX-R gaming intervention for preventing depression and improving wellbeing among adolescents in alternative education (2017) · cites this paper as James et al., 2015

    The review’s ‘How the intervention might work’ section describes teaching children and adolescents to change anxious thoughts and behaviours. Its ‘Secondary outcomes 1.3 Reduction in anxiety symptoms’ section reports reduced anxiety symptoms with CBT. The cited review does not establish the claimed reduction in depression symptoms, and its evidence concerns children and adolescents with anxiety disorders rather than people generally. (LLM, conf=0.88)

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  • Two previous reviews in adults demonstrated that CBT could be delivered in fewer sessions without affecting a successful outcome.

    “In fact, two previous reviews in adults had demonstrated that CBT could be delivered in fewer sessions, without affecting a successful outcome 24,25 .”

    From Cognitive behaviour therapy for anxious paediatric dental patients: a systematic review. (2018) · cites this paper as [25]

    The Discussion (Summary of main results; page unavailable) says the number of CBT sessions did not substantially affect outcomes, but this finding concerns children and adolescents and is qualified by the restricted range of session counts reviewed. The cited paper does not report that two reviews in adults demonstrated the same finding. (LLM, conf=0.88)

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  • On average 40% of patients do not achieve remission from any anxiety disorder after Coping Cat or similar CBT.

    “on average 40% of patients do not achieve remission from any anxiety disorder (James et al., 2015).”

    From Intolerance of Uncertainty–Focused Treatment for Adolescents With Excessive Worry: A Pilot Feasibility Study (2020) · cites this paper as James et al., 2015

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1 of the 252 references couldn’t be matched to a known paper.

Research works printed but not linked: 2

  1. Essau CA, Conradt J, Ederer EM. Anxiety prevention among school children. Versicherungsmedizin 2004;56:123-30.
  2. Flannery-Schroeder 1998 Flannery-Schroeder EC. Group versus individual cognitive behavioural treatment for anxiety-disordered children. Dissertation Abstracts International 1998;58(10-B):5642.

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Authors
James, A. C., James, G., Cowdrey, F. A., Soler, A., & Choke, A.
Affiliations
  • Warneford Hospital (GB)
  • Sunderland Royal Hospital (GB)
  • University of Bath (GB)
ORCID
James, Anthony C
Venue
Cochrane Database of Systematic Reviews
Publisher
Wiley
Published
2015-02-18
Volume
2020
Issue
11
Pages
CD004690-CD004690
ISSN
  • 1361-6137 (ISSN-L)
  • 1465-1858
DOI
10.1002/14651858.cd004690.pub4
PMC
PMC6491167
OpenAlex
W1922301328
Cited by
876
References
252
Citations by year
2026: 6 · 2025: 22 · 2024: 39 · 2023: 55 · 2022: 69 · 2021: 78 · 2020: 70 · 2019: 76 · 2018: 78 · 2017: 54 · 2016: 60 · 2015: 68 · 2014: 45 · 2013: 27 · 2012: 27
FWCI
11.26
Type
journal article
Language
en
Open access
Locations
  • Cochrane Database of Systematic Reviews (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • American Academy of Child and Adolescent Psychiatry
  • National Institute of Mental Health
Topics
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
  • Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
  • Social Sciences › Psychology › Clinical Psychology › Psychological Treatments and Assessments
Keywords
cognitive behavioral therapy, childhood anxiety disorders, adolescent anxiety disorders, anxiety remission, long-term treatment outcomes, medication adherence, relapse, treatment discontinuation, bibliotherapy, usual care, school-based treatment, waitlist control, children and adolescents, anxiety symptoms, relapse prevention
MeSH terms
Adolescent, Anxiety Disorders, Child, Humans, Cognitive Behavioral Therapy, Randomized Controlled Trials as Topic

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