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Novel Group Exposure Therapy Improves Adolescent Anxiety Over Time

Jolynn Tumolo

An adolescent anxiety disorder treatment program that combines group cognitive behavioral therapy (CBT) with high degrees of exposure practice, and which includes family and school involvement, was superior to other studied interventions at a 12-month post-treatment follow-up, according to a study published in Psychiatry Research.

“The combination of group format, a high degree of exposure practice, and school and family involvement is a promising format for real-world settings that may help sustain and increase treatment effectiveness,” Thomas B. Bertelsenchers, Department of Child and Adolescence Mental Health, Sørlandet Sykehus, Kristiansand, Norway, and co-authors wrote in the study.

Study participants included 90 adolescents, among whom 82% had a primary diagnosis of anxiety disorder and 18% had a primary diagnosis of obsessive-compulsive disorder, and their families. The treatment consisted of 12 sessions spanning a total 38 hours, including two 1.5-hour sessions with school personnel, over 10 weeks. Families could also attend 2-hour follow-up booster sessions at 3-, 6-, and 12-months post-treatment.

Quiz: What percentage of children with ADHD had a comorbid anxiety or fear disorder?

“This study examines the effectiveness of the multi-family group CBT (RISK) that includes 3 important enhancement approaches for adolescents: extensive and systematic family involvement, engagement of school personnel, and a high degree of self-conducted and therapist/family/peer-facilitated exposure practice,” researchers wrote. “The study design was a single arm open trial, and comparative effectiveness was assessed through benchmarking against a recent meta-analysis on the effectiveness of CBT for children and adolescents with anxiety disorders and symptoms.”

According to the study, a post-treatment assessment found RISK treatment to be comparably effective to benchmarks on measures of diagnostic status, parent-rated measures, adolescent-rated measures, and clinician-rated measures. At 12-month follow-up assessment, all RISK outcomes were superior to benchmarks, indicating that treatment enhanced effectiveness over time.

“At post-treatment and at the 12-month follow-up, 41.6% and 85.9%, respectively, of those who completed treatment were free of all anxiety diagnoses,” researchers wrote. “This substantial increase in effectiveness, from post-treatment to the 12-month follow-up, was not due to receiving additional therapy. Only 12.5% of those who achieved remission at the follow-up received any additional therapy.”

Researchers suspect the partial transfer of control from the clinician to parents and school personnel after treatment may have helped sustain adult support and treatment adherence. Additionally, parental involvement may have bettered trust and communication within families and protected against anxiety.

 

Reference

Bertelsen TB, Wergeland GJ, Nordgreen T, Himle JA, Håland ÅT. Benchmarked effectiveness of family and school involvement in group exposure therapy for adolescent anxiety disorder. Psychiatry Res. 2022;313:114632. doi: 10.1016/j.psychres.2022.114632

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