Cited by 1,442Anxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesChild and Adolescent Psychosocial and Emotional DevelopmentPsychotherapy Techniques and Applications

The DOI matches its Crossref record; 29 of the 30 references it cites were found in a registry or an index.

Cognitive Behavioral Therapy, Sertraline, or a Combination in Childhood Anxiety

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Abstract

BACKGROUND: Anxiety disorders are common psychiatric conditions affecting children and adolescents. Although cognitive behavioral therapy and selective serotonin-reuptake inhibitors have shown efficacy in treating these disorders, little is known about their relative or combined efficacy. METHODS: In this randomized, controlled trial, we assigned 488 children between the ages of 7 and 17 years who had a primary diagnosis of separation anxiety disorder, generalized anxiety disorder, or social phobia to receive 14 sessions of cognitive behavioral therapy, sertraline (at a dose of up to 200 mg per day), a combination of sertraline and cognitive behavioral therapy, or a placebo drug for 12 weeks in a 2:2:2:1 ratio. We administered categorical and dimensional ratings of anxiety severity and impairment at baseline and at weeks 4, 8, and 12. RESULTS: The percentages of children who were rated as very much or much improved on the Clinician Global Impression-Improvement scale were 80.7% for combination therapy (P<0.001), 59.7% for cognitive behavioral therapy (P<0.001), and 54.9% for sertraline (P<0.001); all therapies were superior to placebo (23.7%). Combination therapy was superior to both monotherapies (P<0.001). Results on the Pediatric Anxiety Rating Scale documented a similar magnitude and pattern of response; combination therapy had a greater response than cognitive behavioral therapy, which was equivalent to sertraline, and all therapies were superior to placebo. Adverse events, including suicidal and homicidal ideation, were no more frequent in the sertraline group than in the placebo group. No child attempted suicide. There was less insomnia, fatigue, sedation, and restlessness associated with cognitive behavioral therapy than with sertraline. CONCLUSIONS: Both cognitive behavioral therapy and sertraline reduced the severity of anxiety in children with anxiety disorders; a combination of the two therapies had a superior response rate. (ClinicalTrials.gov number, NCT00052078.)

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Research works printed but not linked: 2

  1. James A, 2005, Cochrane Database Syst Rev, 4, CD004690
  2. Albano AM, Silverman WK. The anxiety disorders interview schedule for DSM-IV, child version: clinician manual. New York: Oxford University Press, 1996.

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Metadata

Authors
Walkup, J. T., Albano, A. M., Piacentini, J., Birmaher, B., Compton, S. N., Sherrill, J. T., Ginsburg, G. S., Rynn, M. A., McCracken, J., Waslick, B., Iyengar, S., March, J. S., & Kendall, P. C.
Affiliations
  • Johns Hopkins University (US)
  • Columbia University Irving Medical Center (US)
  • University of California, Los Angeles (US)
  • University of Pittsburgh Medical Center (US)
  • Duke Medical Center (US)
  • National Institute of Mental Health (US)
  • Baystate Medical Center (US)
  • Temple University (US)
Venue
New England Journal of Medicine
Published
2008-12-25
Volume
359
Issue
26
Pages
2753-2766
ISSN
  • 0028-4793 (ISSN-L)
  • 1533-4406
OpenAlex
W2131873172
Cited by
1,442
References
30
Citations by year
2026: 46 · 2025: 46 · 2024: 64 · 2023: 63 · 2022: 92 · 2021: 97 · 2020: 85 · 2019: 91 · 2018: 93 · 2017: 89 · 2016: 85 · 2015: 109 · 2014: 88 · 2013: 100 · 2012: 82
FWCI
95.27
Type
journal article
Language
en
Open access
Locations
  • New England Journal of Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Institute of Mental Health (U01MH64088, U01MH64107, U01MH64003, U01MH064088, U01MH064107, U01MH64092, U01MH064089, U01MH064092, U01MH63747, U01MH064003, U01MH063747, L40 MH072315, K23MH075843)
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 › Psychotherapy Techniques and Applications
Keywords
childhood anxiety disorders, cognitive behavioral therapy, sertraline, selective serotonin reuptake inhibitors, combination therapy, separation anxiety disorder, generalized anxiety disorder, social anxiety disorder, treatment efficacy, adverse events, suicidal ideation, insomnia
MeSH terms
Adolescent, Anxiety Disorders, Child, Combined Modality Therapy, Female, Humans, Male, Cognitive Behavioral Therapy, Treatment Outcome, Selective Serotonin Reuptake Inhibitors, Sertraline

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