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Treating Anxiety Disorders in Inner City Schools: Results from a Pilot Randomized Controlled Trial Comparing CBT and Usual Care

Abstract

Background  

The effectiveness of cognitive-behavioral treatment (CBT) in inner city schools, when delivered by novice CBT clinicians,
and compared to usual care (UC), is unknown.

Objective  

This pilot study addressed this issue by comparing a modular CBT for anxiety disorders to UC in a sample of 32 volunteer youth
(mean age 10.28 years, 63% female, 84% African American) seen in school-based mental health programs.

Methods  

Youth were randomly assigned to CBT (n = 17) or UC (n = 15); independent evaluators conducted diagnostic interviews with children and parents at pre- and post-intervention, and
at a one-month follow-up.

Results  

Based on intent-to-treat analyses, no differences were found in response rates between groups with 50 and 42% of the children
in CBT, compared to 46 and 57% in UC no longer meeting criteria for an anxiety disorder at post-treatment and follow-up respectively.
Similar improvements in global functioning were also found in both treatment groups. Baseline predictors of a positive treatment
response included lower anxiety, fewer maladaptive thoughts, less exposure to urban hassles, and lower levels of parenting
stress. Therapist use of more CBT session structure elements and greater competence in implementing these elements was also
related to a positive treatment response.

Conclusions  

Findings from this small pilot failed to show that CBT was superior to UC when delivered by school-based clinicians. Large
scale comparative effectiveness trials are needed to determine whether CBT leads to superior clinical outcomes prior to dissemination.

  • Content Type Journal Article
  • Category Original Paper
  • Pages 1-19
  • DOI 10.1007/s10566-011-9156-4
  • Authors
    • Golda S. Ginsburg, Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, 550 North Broadway/Suite 202, Baltimore, MD 21205, USA
    • Kimberly D. Becker, Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, 550 North Broadway/Suite 202, Baltimore, MD 21205, USA
    • Tess K. Drazdowski, Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, 550 North Broadway/Suite 202, Baltimore, MD 21205, USA
    • Jenn-Yun Tein, Department of Psychology, Arizona State University, Tempe, AZ, USA
    • Journal Child and Youth Care Forum
    • Online ISSN 1573-3319
    • Print ISSN 1053-1890
Posted in: Journal Article Abstracts on 11/27/2011 | Link to this post on IFP |
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