UH Hilo psychologist and colleagues review 50 years of research on child anxiety treatment
The review, published in the Journal of Clinical Child and Adolescent Psychology, looks at evidence-based results, revealing the most appropriate lines of treatment.
Charmaine Higa-McMillan, associate professor of psychology at the University of Hawaii at Hilo, with colleagues on the mainland, reviewed 111 studies on child and adolescent anxiety and identified six treatments for anxiety disorders as “well established,” the best level of research support.
Other authors of the review are Sarah Francis from the Department of Psychology at the University of Toledo, and Leslie Rith Najarian and Bruce Chorpita from the Department of Psychology at the University of California-Los Angeles.
The review, “Evidence Base Update: 50 Years of Research on Treatment for Child and Adolescent Anxiety,” published in the Journal of Clinical Child and Adolescent Psychology, found that among the six treatments, cognitive behavioral therapy (CBT) is most studied and is an appropriate first line treatment for youth with anxiety disorders.
The review is part of a series in the journal to update the evidence-based literature in youth mental health treatment.
- Download review (PDF)
Components of the top treatments include exposure, cognitive restructuring, relaxation, psychoeducation, and modeling.
For example, exposure involves direct or imagined experience with the feared object or situation. Cognitive restructuring involves working with youth to alter the ways in which events or situations are viewed, often by generating and practicing more realistic, alternative counter thoughts.
The importance of evidence-based treatment
Higa-McMillan says the field of clinical psychology began discussing the importance of evidence-based treatment about two decades ago with noted reports such as the American Psychological Association’s Task Force on the Promotion and Dissemination of Psychological Procedures in 1995. In 1998, psychologists Thomas Ollendick and Neville King reviewed the literature for child anxiety, and then in 2008 Wendy Silvermana, Armando Pinab and Chockalingam Viswesvaranc provided an update to this review.
“Given that the treatment outcome literature continues to grow with new research published regularly, it is important for clinicians and researchers to remain abreast of the latest and greatest when it comes to what works for whom,” explains Higa-McMillan. “In our review we expand on Ollendick and Silverman’s reviews by including analysis not only on symptom reduction but also on treatments that improve functioning. CBT was the only treatment to reach the best level of support at improving functioning and reducing symptoms, whereas six reached best level of support when just looking at symptom reduction.”
She adds, “We also provide a description of the techniques derived from evidence-based treatments for youth anxiety. This is important because most clinicians are aware at this point that cognitive-behavioral therapy is well-established for youth anxiety but there are many CBT protocols that have been tested in the literature and each include a number of different strategies. We coded all of these protocols and provide clinicians with the most commonly occurring strategies across evidence-based treatments to give them a better sense of the specific practices that have been studied.”
For instance, she cites, exposure shows up in eighty-eight percent of evidence-based treatments suggesting that if you are going to select one strategy to use with an anxious youth, you should probably consider this approach. On the other hand, although play therapy (as an example) was included in two evidence-based treatments for youth anxiety, this only represents one percent of all clinical trials that were coded.
Anxiety disorders and the efficacy of treatments
Anxiety disorders represent the most common mental health disorder among both children and adolescents. They also are associated with numerous negative mental health outcomes, including the development of subsequent anxiety disorders, depression, substance misuse, and poor school performance. Fortunately for children, adolescents, families and communities, research has led to many effective talk therapies.
In addition to Higa-McMillan and team identifying the top six treatments, several other treatments found support in studies that were not primarily CBT based, reaching the second best level of support. These include cultural storytelling for Hispanic youth with subclinical anxiety and hypnosis for test anxiety.
“We also looked at treatments that have been tested and failed to work for youth anxiety,” Higa-McMillan says. “Interestingly, we found that EMDR (eye movement desensitization and reprocessing) does not work for youth anxiety, despite the fact that it has been shown to work for adults with anxiety.”
Additionally, other treatments that focus on supportive listening or nondirective approaches only, instead of directly addressing the client’s fears such as client centered therapy and relationship counseling, were also identified as lacking support.
“As our field learns more about what works, we also need to attend to what does not work and what has been demonstrated to cause harm,” says Higa-McMillan, noting that the review did not look at the latter.
About the writer of this story: Susan Enright is a public information specialist for the Office of the Chancellor and editor of UH Hilo Stories. She received her bachelor of arts in English and certificate in women’s studies from UH Hilo.
