Group cognitive behavioral therapy and attention bias modification for childhood anxiety disorders: A factorial randomized trial of efficacy

Giovanni A. Salum, Circe S. Petersen, Rafaela B. Jarros, Rudineia Toazza, Diogo Desousa, Lidiane Nunes Borba, Stela Castro, Julia Gallegos, Paula Barrett, Rany Abend, Yair Bar-Haim, Daniel S. Pine, Silvia H. Koller, Gisele G. Manfro

Research output: Contribution to journalArticle

Abstract

Background: The objective of this study is to assess group differences in symptom reduction between individuals receiving group cognitive behavioral therapy (G-CBT) and attention bias modification (ABM) compared to their respective control interventions, control therapy (CT), and attention control training (ACT), in a 2 × 2 factorial design. Methods: A total of 310 treatment-naive children (7-11 years of age) were assessed for eligibility and 79 children with generalized, separation or social anxiety disorder were randomized and received G-CBT (n = 42) or CT (n = 37). Within each psychotherapy group, participants were again randomized to ABM (n = 38) or ACT (n = 41) in a 2 × 2 factorial design resulting in four groups: G-CBT + ABM (n = 21), G-CBT + ACT (n = 21), CT + ABM (n = 17), and CT + ACT (n = 20). Primary outcomes were responder designation as defined by Clinical Global Impression-Improvement (CGI-I) scale (≤2) and change on the Pediatric Anxiety Rating Scale (PARS). Results: There were significant improvements of symptoms in all groups. No differences in response rates or mean differences in PARS scores were found among groups: G-CBT + ABM group (23.8% response; 3.9 points, 95% confidence interval [CI]-0.3 to 8.1), G-CBT + ACT (42.9% response; 5.6 points, 95% CI 2.2-9.0), CT + ABM (47.1% response; 4.8 points 95% CI 1.08-8.57), and CT + ACT (30% response; 0.8 points, 95% CI-3.0 to 4.7). No evidence or synergic or antagonistic effects were found, but the combination of G-CBT and ABM was found to increase dropout rate. Conclusions: We found no effect of G-CBT or ABM beyond the effects of comparison groups. Results reveal no benefit from combining G-CBT and ABM for anxiety disorders in children and suggest potential deleterious effects of the combination on treatment acceptability.

Original languageEnglish
Pages (from-to)620-630
Number of pages11
JournalJournal of Child and Adolescent Psychopharmacology
Volume28
Issue number9
DOIs
Publication statusPublished - 1 Nov 2018

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Cognitive Therapy
Anxiety Disorders
Confidence Intervals
Therapeutics
Anxiety
Separation Anxiety
Pediatrics
Group Psychotherapy

All Science Journal Classification (ASJC) codes

  • Pediatrics, Perinatology, and Child Health
  • Psychiatry and Mental health
  • Pharmacology (medical)

Cite this

Salum, Giovanni A. ; Petersen, Circe S. ; Jarros, Rafaela B. ; Toazza, Rudineia ; Desousa, Diogo ; Borba, Lidiane Nunes ; Castro, Stela ; Gallegos, Julia ; Barrett, Paula ; Abend, Rany ; Bar-Haim, Yair ; Pine, Daniel S. ; Koller, Silvia H. ; Manfro, Gisele G. / Group cognitive behavioral therapy and attention bias modification for childhood anxiety disorders : A factorial randomized trial of efficacy. In: Journal of Child and Adolescent Psychopharmacology. 2018 ; Vol. 28, No. 9. pp. 620-630.
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abstract = "Background: The objective of this study is to assess group differences in symptom reduction between individuals receiving group cognitive behavioral therapy (G-CBT) and attention bias modification (ABM) compared to their respective control interventions, control therapy (CT), and attention control training (ACT), in a 2 × 2 factorial design. Methods: A total of 310 treatment-naive children (7-11 years of age) were assessed for eligibility and 79 children with generalized, separation or social anxiety disorder were randomized and received G-CBT (n = 42) or CT (n = 37). Within each psychotherapy group, participants were again randomized to ABM (n = 38) or ACT (n = 41) in a 2 × 2 factorial design resulting in four groups: G-CBT + ABM (n = 21), G-CBT + ACT (n = 21), CT + ABM (n = 17), and CT + ACT (n = 20). Primary outcomes were responder designation as defined by Clinical Global Impression-Improvement (CGI-I) scale (≤2) and change on the Pediatric Anxiety Rating Scale (PARS). Results: There were significant improvements of symptoms in all groups. No differences in response rates or mean differences in PARS scores were found among groups: G-CBT + ABM group (23.8{\%} response; 3.9 points, 95{\%} confidence interval [CI]-0.3 to 8.1), G-CBT + ACT (42.9{\%} response; 5.6 points, 95{\%} CI 2.2-9.0), CT + ABM (47.1{\%} response; 4.8 points 95{\%} CI 1.08-8.57), and CT + ACT (30{\%} response; 0.8 points, 95{\%} CI-3.0 to 4.7). No evidence or synergic or antagonistic effects were found, but the combination of G-CBT and ABM was found to increase dropout rate. Conclusions: We found no effect of G-CBT or ABM beyond the effects of comparison groups. Results reveal no benefit from combining G-CBT and ABM for anxiety disorders in children and suggest potential deleterious effects of the combination on treatment acceptability.",
author = "Salum, {Giovanni A.} and Petersen, {Circe S.} and Jarros, {Rafaela B.} and Rudineia Toazza and Diogo Desousa and Borba, {Lidiane Nunes} and Stela Castro and Julia Gallegos and Paula Barrett and Rany Abend and Yair Bar-Haim and Pine, {Daniel S.} and Koller, {Silvia H.} and Manfro, {Gisele G.}",
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Salum, GA, Petersen, CS, Jarros, RB, Toazza, R, Desousa, D, Borba, LN, Castro, S, Gallegos, J, Barrett, P, Abend, R, Bar-Haim, Y, Pine, DS, Koller, SH & Manfro, GG 2018, 'Group cognitive behavioral therapy and attention bias modification for childhood anxiety disorders: A factorial randomized trial of efficacy' Journal of Child and Adolescent Psychopharmacology, vol. 28, no. 9, pp. 620-630. https://doi.org/10.1089/cap.2018.0022

Group cognitive behavioral therapy and attention bias modification for childhood anxiety disorders : A factorial randomized trial of efficacy. / Salum, Giovanni A.; Petersen, Circe S.; Jarros, Rafaela B.; Toazza, Rudineia; Desousa, Diogo; Borba, Lidiane Nunes; Castro, Stela; Gallegos, Julia; Barrett, Paula; Abend, Rany; Bar-Haim, Yair; Pine, Daniel S.; Koller, Silvia H.; Manfro, Gisele G.

In: Journal of Child and Adolescent Psychopharmacology, Vol. 28, No. 9, 01.11.2018, p. 620-630.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Group cognitive behavioral therapy and attention bias modification for childhood anxiety disorders

T2 - A factorial randomized trial of efficacy

AU - Salum, Giovanni A.

AU - Petersen, Circe S.

AU - Jarros, Rafaela B.

AU - Toazza, Rudineia

AU - Desousa, Diogo

AU - Borba, Lidiane Nunes

AU - Castro, Stela

AU - Gallegos, Julia

AU - Barrett, Paula

AU - Abend, Rany

AU - Bar-Haim, Yair

AU - Pine, Daniel S.

AU - Koller, Silvia H.

AU - Manfro, Gisele G.

PY - 2018/11/1

Y1 - 2018/11/1

N2 - Background: The objective of this study is to assess group differences in symptom reduction between individuals receiving group cognitive behavioral therapy (G-CBT) and attention bias modification (ABM) compared to their respective control interventions, control therapy (CT), and attention control training (ACT), in a 2 × 2 factorial design. Methods: A total of 310 treatment-naive children (7-11 years of age) were assessed for eligibility and 79 children with generalized, separation or social anxiety disorder were randomized and received G-CBT (n = 42) or CT (n = 37). Within each psychotherapy group, participants were again randomized to ABM (n = 38) or ACT (n = 41) in a 2 × 2 factorial design resulting in four groups: G-CBT + ABM (n = 21), G-CBT + ACT (n = 21), CT + ABM (n = 17), and CT + ACT (n = 20). Primary outcomes were responder designation as defined by Clinical Global Impression-Improvement (CGI-I) scale (≤2) and change on the Pediatric Anxiety Rating Scale (PARS). Results: There were significant improvements of symptoms in all groups. No differences in response rates or mean differences in PARS scores were found among groups: G-CBT + ABM group (23.8% response; 3.9 points, 95% confidence interval [CI]-0.3 to 8.1), G-CBT + ACT (42.9% response; 5.6 points, 95% CI 2.2-9.0), CT + ABM (47.1% response; 4.8 points 95% CI 1.08-8.57), and CT + ACT (30% response; 0.8 points, 95% CI-3.0 to 4.7). No evidence or synergic or antagonistic effects were found, but the combination of G-CBT and ABM was found to increase dropout rate. Conclusions: We found no effect of G-CBT or ABM beyond the effects of comparison groups. Results reveal no benefit from combining G-CBT and ABM for anxiety disorders in children and suggest potential deleterious effects of the combination on treatment acceptability.

AB - Background: The objective of this study is to assess group differences in symptom reduction between individuals receiving group cognitive behavioral therapy (G-CBT) and attention bias modification (ABM) compared to their respective control interventions, control therapy (CT), and attention control training (ACT), in a 2 × 2 factorial design. Methods: A total of 310 treatment-naive children (7-11 years of age) were assessed for eligibility and 79 children with generalized, separation or social anxiety disorder were randomized and received G-CBT (n = 42) or CT (n = 37). Within each psychotherapy group, participants were again randomized to ABM (n = 38) or ACT (n = 41) in a 2 × 2 factorial design resulting in four groups: G-CBT + ABM (n = 21), G-CBT + ACT (n = 21), CT + ABM (n = 17), and CT + ACT (n = 20). Primary outcomes were responder designation as defined by Clinical Global Impression-Improvement (CGI-I) scale (≤2) and change on the Pediatric Anxiety Rating Scale (PARS). Results: There were significant improvements of symptoms in all groups. No differences in response rates or mean differences in PARS scores were found among groups: G-CBT + ABM group (23.8% response; 3.9 points, 95% confidence interval [CI]-0.3 to 8.1), G-CBT + ACT (42.9% response; 5.6 points, 95% CI 2.2-9.0), CT + ABM (47.1% response; 4.8 points 95% CI 1.08-8.57), and CT + ACT (30% response; 0.8 points, 95% CI-3.0 to 4.7). No evidence or synergic or antagonistic effects were found, but the combination of G-CBT and ABM was found to increase dropout rate. Conclusions: We found no effect of G-CBT or ABM beyond the effects of comparison groups. Results reveal no benefit from combining G-CBT and ABM for anxiety disorders in children and suggest potential deleterious effects of the combination on treatment acceptability.

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