For acute mental stress in children, this psychotherapy looks best

  • Zhou X & al.
  • JAMA Psychiatry
  • 31 Oct 2018

  • curated by Jim Kling
  • Clinical Essentials
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Takeaway

  • In children and adolescents with acute anxiety, a network meta-analysis of 11 psychotherapies revealed that only group cognitive behavioral therapy (CBT) was significantly more effective than the other psychotherapies and control conditions.
  • More research is necessary to determine the best therapies for individual anxiety disorders.

Why this matters

  • Debate continues about the best psychotherapy components and format for acute anxiety in this population, with few comparison studies.
  • The results suggest that group CBT may be the first choice for psychological therapy in this population.

Study design

  • Network meta-analysis of 101 randomized controlled trials including 6625 participants (treatment, 11 different psychotherapies; 4 control conditions).
  • Funding: NIHR Oxford Cognitive Health Clinical Research Facility; Others.

Key results

  • Most psychotherapies were significantly more effective than the waitlist control condition and no treatment (standardized mean difference [SMD] range, −2.80 to −1.64) at the end of follow-up (≤12 months).
  • Group CBT was more effective than group CBT+ parenteral involvement and all control conditions at short-term follow-up (SMD range, −0.43 to −0.82).
  • In terms of QoL/functioning, most CBT, but not behavioral therapy, showed significantly more benefit than psychological placebo and the waitlist condition (SMD range, 0.73-1.99).

Limitations

  • Small number of trials.
  • Risk of bias.

Coauthored with Chitra Ravi, MPharm

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