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Technology‐delivered cognitive‐behavioral therapy for pediatric anxiety disorders: a meta‐analysis of remission, posttreatment anxiety, and functioning

Cervin, Matti LU and Lundgren, Tobias (2021) In Journal of Child Psychology and Psychiatry
Abstract
BackgroundThe efficacy of technology-delivered cognitive-behavioral therapy (tCBT) for pediatric anxiety disorders (ADs) is uncertain as no meta-analysis has examined outcomes in trials that used structured diagnostic assessments at pre- and posttreatment.MethodsWe carried out a systematic review and meta-analysis of randomized controlled trials (RCTs) of tCBT for pediatric ADs that included participants <18 years of age with a confirmed primary AD according to a structured diagnostic interview. Nine studies with 711 participants were included.ResultstCBT outperformed control conditions for remission for primary AD (37.9% vs. 10.2%; k = 9; OR = 4.73; p < .0001; I2 = 0%; moderate certainty), remission for all ADs (19.5% vs. 5.3%; k =... (More)
BackgroundThe efficacy of technology-delivered cognitive-behavioral therapy (tCBT) for pediatric anxiety disorders (ADs) is uncertain as no meta-analysis has examined outcomes in trials that used structured diagnostic assessments at pre- and posttreatment.MethodsWe carried out a systematic review and meta-analysis of randomized controlled trials (RCTs) of tCBT for pediatric ADs that included participants <18 years of age with a confirmed primary AD according to a structured diagnostic interview. Nine studies with 711 participants were included.ResultstCBT outperformed control conditions for remission for primary AD (37.9% vs. 10.2%; k = 9; OR = 4.73; p < .0001; I2 = 0%; moderate certainty), remission for all ADs (19.5% vs. 5.3%; k = 8; OR = 3.32; p < .0001; I2 = 0%; moderate certainty), clinician-rated functioning (k = 7; MD = −4.38; p < .001; I2 = 56.9%; low certainty), and caregiver-reported anxiety (k = 7; SMD = 0.27; p = .02; I2 = 41.4%; low certainty), but not for youth-reported anxiety (k = 9; SMD = 0.13; p = .12; I2 = 0%; low certainty). More severe pretreatment anxiety, a lower proportion of completed sessions, no face-to-face sessions, media recruitment, and a larger proportion of females were associated with lower remission rates for primary AD.ConclusionstCBT has a moderate effect on remission for pediatric ADs and clinician-rated functioning, a small effect on caregiver-reported anxiety, and no statistically significant effect on youth-reported anxiety. The certainty of these estimates is low to moderate. Remission rates vary substantially across trials and several factors that may influence remission were identified. Future research should examine for whom tCBT is most appropriate and what care to offer the large proportion that does not remit. Future RCTs should consider contrasting tCBT with partial tCBT (e.g., including therapist-led exposure) and/or face-to-face CBT. (Less)
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author
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organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Journal of Child Psychology and Psychiatry
publisher
Wiley-Blackwell
external identifiers
  • scopus:85109399006
  • pmid:34235730
ISSN
0021-9630
DOI
10.1111/jcpp.13485
language
English
LU publication?
yes
id
9a44d4ae-f243-4737-aad7-b92401583ace
date added to LUP
2021-07-08 14:25:21
date last changed
2024-02-20 09:05:19
@article{9a44d4ae-f243-4737-aad7-b92401583ace,
  abstract     = {{BackgroundThe efficacy of technology-delivered cognitive-behavioral therapy (tCBT) for pediatric anxiety disorders (ADs) is uncertain as no meta-analysis has examined outcomes in trials that used structured diagnostic assessments at pre- and posttreatment.MethodsWe carried out a systematic review and meta-analysis of randomized controlled trials (RCTs) of tCBT for pediatric ADs that included participants &lt;18 years of age with a confirmed primary AD according to a structured diagnostic interview. Nine studies with 711 participants were included.ResultstCBT outperformed control conditions for remission for primary AD (37.9% vs. 10.2%; k = 9; OR = 4.73; p &lt; .0001; I2 = 0%; moderate certainty), remission for all ADs (19.5% vs. 5.3%; k = 8; OR = 3.32; p &lt; .0001; I2 = 0%; moderate certainty), clinician-rated functioning (k = 7; MD = −4.38; p &lt; .001; I2 = 56.9%; low certainty), and caregiver-reported anxiety (k = 7; SMD = 0.27; p = .02; I2 = 41.4%; low certainty), but not for youth-reported anxiety (k = 9; SMD = 0.13; p = .12; I2 = 0%; low certainty). More severe pretreatment anxiety, a lower proportion of completed sessions, no face-to-face sessions, media recruitment, and a larger proportion of females were associated with lower remission rates for primary AD.ConclusionstCBT has a moderate effect on remission for pediatric ADs and clinician-rated functioning, a small effect on caregiver-reported anxiety, and no statistically significant effect on youth-reported anxiety. The certainty of these estimates is low to moderate. Remission rates vary substantially across trials and several factors that may influence remission were identified. Future research should examine for whom tCBT is most appropriate and what care to offer the large proportion that does not remit. Future RCTs should consider contrasting tCBT with partial tCBT (e.g., including therapist-led exposure) and/or face-to-face CBT.}},
  author       = {{Cervin, Matti and Lundgren, Tobias}},
  issn         = {{0021-9630}},
  language     = {{eng}},
  month        = {{07}},
  publisher    = {{Wiley-Blackwell}},
  series       = {{Journal of Child Psychology and Psychiatry}},
  title        = {{Technology‐delivered cognitive‐behavioral therapy for pediatric anxiety disorders: a meta‐analysis of remission, posttreatment anxiety, and functioning}},
  url          = {{http://dx.doi.org/10.1111/jcpp.13485}},
  doi          = {{10.1111/jcpp.13485}},
  year         = {{2021}},
}