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Technology-delivered cognitive-behavioral therapy for pediatric anxiety disorders: a meta-analysis of remission, posttreatment anxiety, and functioning / Matti CERVIN in Journal of Child Psychology and Psychiatry, 63-1 (January 2022)
[article]
Titre : Technology-delivered cognitive-behavioral therapy for pediatric anxiety disorders: a meta-analysis of remission, posttreatment anxiety, and functioning Type de document : Texte imprimé et/ou numérique Auteurs : Matti CERVIN, Auteur ; T. LUNDGREN, Auteur Article en page(s) : p.7-18 Langues : Anglais (eng) Mots-clés : Adolescent Anxiety Anxiety Disorders/therapy Child Cognitive Behavioral Therapy Female Humans Technology Anxiety disorders adolescents children iCBT internet meta-analysis tCBT technology Index. décimale : PER Périodiques Résumé : BACKGROUND: The efficacy of technology-delivered cognitive-behavioral therapy (tCBT) for pediatric anxiety disorders (ADs) is uncertain as no meta-analysis has examined outcomes in trials that used structured diagnostic assessments at pre- and posttreatment. METHODS: We carried out a systematic review and meta-analysis of randomized controlled trials (RCTs) of tCBT for pediatric ADs that included participants <18?years of age with a confirmed primary AD according to a structured diagnostic interview. Nine studies with 711 participants were included. RESULTS: tCBT outperformed control conditions for remission for primary AD (37.9% vs. 10.2%; k?=?9; OR?=?4.73; p?.0001; I(2) ?=?0%; moderate certainty), remission for all ADs (19.5% vs. 5.3%; k?=?8; OR?=?3.32; p?.0001; I(2) ?=?0%; moderate certainty), clinician-rated functioning (k?=?7; MD?=?-4.38; p?.001; I(2) ?=?56.9%; low certainty), and caregiver-reported anxiety (k?=?7; SMD?=?0.27; p?=?.02; I(2) ?=?41.4%; low certainty), but not for youth-reported anxiety (k?=?9; SMD?=?0.13; p?=?.12; I(2) ?=?0%; low certainty). More severe pretreatment anxiety, a lower proportion of completed sessions, no face-to-face sessions, media recruitment, and a larger proportion of females were associated with lower remission rates for primary AD. CONCLUSIONS: tCBT has a moderate effect on remission for pediatric ADs and clinician-rated functioning, a small effect on caregiver-reported anxiety, and no statistically significant effect on youth-reported anxiety. The certainty of these estimates is low to moderate. Remission rates vary substantially across trials and several factors that may influence remission were identified. Future research should examine for whom tCBT is most appropriate and what care to offer the large proportion that does not remit. Future RCTs should consider contrasting tCBT with partial tCBT (e.g., including therapist-led exposure) and/or face-to-face CBT. En ligne : http://dx.doi.org/10.1111/jcpp.13485 Permalink : https://www.cra-rhone-alpes.org/cid/opac_css/index.php?lvl=notice_display&id=456
in Journal of Child Psychology and Psychiatry > 63-1 (January 2022) . - p.7-18[article] Technology-delivered cognitive-behavioral therapy for pediatric anxiety disorders: a meta-analysis of remission, posttreatment anxiety, and functioning [Texte imprimé et/ou numérique] / Matti CERVIN, Auteur ; T. LUNDGREN, Auteur . - p.7-18.
Langues : Anglais (eng)
in Journal of Child Psychology and Psychiatry > 63-1 (January 2022) . - p.7-18
Mots-clés : Adolescent Anxiety Anxiety Disorders/therapy Child Cognitive Behavioral Therapy Female Humans Technology Anxiety disorders adolescents children iCBT internet meta-analysis tCBT technology Index. décimale : PER Périodiques Résumé : BACKGROUND: The efficacy of technology-delivered cognitive-behavioral therapy (tCBT) for pediatric anxiety disorders (ADs) is uncertain as no meta-analysis has examined outcomes in trials that used structured diagnostic assessments at pre- and posttreatment. METHODS: We carried out a systematic review and meta-analysis of randomized controlled trials (RCTs) of tCBT for pediatric ADs that included participants <18?years of age with a confirmed primary AD according to a structured diagnostic interview. Nine studies with 711 participants were included. RESULTS: tCBT outperformed control conditions for remission for primary AD (37.9% vs. 10.2%; k?=?9; OR?=?4.73; p?.0001; I(2) ?=?0%; moderate certainty), remission for all ADs (19.5% vs. 5.3%; k?=?8; OR?=?3.32; p?.0001; I(2) ?=?0%; moderate certainty), clinician-rated functioning (k?=?7; MD?=?-4.38; p?.001; I(2) ?=?56.9%; low certainty), and caregiver-reported anxiety (k?=?7; SMD?=?0.27; p?=?.02; I(2) ?=?41.4%; low certainty), but not for youth-reported anxiety (k?=?9; SMD?=?0.13; p?=?.12; I(2) ?=?0%; low certainty). More severe pretreatment anxiety, a lower proportion of completed sessions, no face-to-face sessions, media recruitment, and a larger proportion of females were associated with lower remission rates for primary AD. CONCLUSIONS: tCBT has a moderate effect on remission for pediatric ADs and clinician-rated functioning, a small effect on caregiver-reported anxiety, and no statistically significant effect on youth-reported anxiety. The certainty of these estimates is low to moderate. Remission rates vary substantially across trials and several factors that may influence remission were identified. Future research should examine for whom tCBT is most appropriate and what care to offer the large proportion that does not remit. Future RCTs should consider contrasting tCBT with partial tCBT (e.g., including therapist-led exposure) and/or face-to-face CBT. En ligne : http://dx.doi.org/10.1111/jcpp.13485 Permalink : https://www.cra-rhone-alpes.org/cid/opac_css/index.php?lvl=notice_display&id=456 Moderators of response to child-based and parent-based child anxiety treatment: a machine learning-based analysis / E. R. LEBOWITZ in Journal of Child Psychology and Psychiatry, 62-10 (October 2021)
[article]
Titre : Moderators of response to child-based and parent-based child anxiety treatment: a machine learning-based analysis Type de document : Texte imprimé et/ou numérique Auteurs : E. R. LEBOWITZ, Auteur ; S. ZILCHA-MANO, Auteur ; M. ORBACH, Auteur ; Y. SHIMSHONI, Auteur ; W. K. SILVERMAN, Auteur Article en page(s) : p.1175-1182 Langues : Anglais (eng) Mots-clés : Anxiety Anxiety Disorders/therapy Child Cognitive Behavioral Therapy Humans Machine Learning Parenting Treatment Outcome behavior therapy machine learning parent training Index. décimale : PER Périodiques Résumé : BACKGROUND: Identifying moderators of response to treatment for childhood anxiety can inform clinical decision-making and improve overall treatment efficacy. We examined moderators of response to child-based cognitive-behavioral therapy (CBT) and parent-based SPACE (Supportive Parenting for Anxious Childhood Emotions) in a recent randomized clinical trial. METHODS: We applied a machine learning approach to identify moderators of treatment response to CBT versus SPACE, in a clinical trial of 124 children with primary anxiety disorders. We tested the clinical benefit of prescribing treatment based on the identified moderators by comparing outcomes for children randomly assigned to their optimal and nonoptimal treatment conditions. We further applied machine learning to explore relations between moderators and shed light on how they interact to predict outcomes. Potential moderators included demographic, socioemotional, parenting, and biological variables. We examined moderation separately for child-reported, parent-reported, and independent-evaluator-reported outcomes. RESULTS: Parent-reported outcomes were moderated by parent negativity and child oxytocin levels. Child-reported outcomes were moderated by baseline anxiety, parent negativity, and parent oxytocin levels. Independent-evaluator-reported outcomes were moderated by baseline anxiety. Children assigned to their optimal treatment condition had significantly greater reduction in anxiety symptoms, compared with children assigned to their nonoptimal treatment. Significant interactions emerged between the identified moderators. CONCLUSIONS: Our findings represent an important step toward optimizing treatment selection and increasing treatment efficacy. En ligne : http://dx.doi.org/10.1111/jcpp.13386 Permalink : https://www.cra-rhone-alpes.org/cid/opac_css/index.php?lvl=notice_display&id=456
in Journal of Child Psychology and Psychiatry > 62-10 (October 2021) . - p.1175-1182[article] Moderators of response to child-based and parent-based child anxiety treatment: a machine learning-based analysis [Texte imprimé et/ou numérique] / E. R. LEBOWITZ, Auteur ; S. ZILCHA-MANO, Auteur ; M. ORBACH, Auteur ; Y. SHIMSHONI, Auteur ; W. K. SILVERMAN, Auteur . - p.1175-1182.
Langues : Anglais (eng)
in Journal of Child Psychology and Psychiatry > 62-10 (October 2021) . - p.1175-1182
Mots-clés : Anxiety Anxiety Disorders/therapy Child Cognitive Behavioral Therapy Humans Machine Learning Parenting Treatment Outcome behavior therapy machine learning parent training Index. décimale : PER Périodiques Résumé : BACKGROUND: Identifying moderators of response to treatment for childhood anxiety can inform clinical decision-making and improve overall treatment efficacy. We examined moderators of response to child-based cognitive-behavioral therapy (CBT) and parent-based SPACE (Supportive Parenting for Anxious Childhood Emotions) in a recent randomized clinical trial. METHODS: We applied a machine learning approach to identify moderators of treatment response to CBT versus SPACE, in a clinical trial of 124 children with primary anxiety disorders. We tested the clinical benefit of prescribing treatment based on the identified moderators by comparing outcomes for children randomly assigned to their optimal and nonoptimal treatment conditions. We further applied machine learning to explore relations between moderators and shed light on how they interact to predict outcomes. Potential moderators included demographic, socioemotional, parenting, and biological variables. We examined moderation separately for child-reported, parent-reported, and independent-evaluator-reported outcomes. RESULTS: Parent-reported outcomes were moderated by parent negativity and child oxytocin levels. Child-reported outcomes were moderated by baseline anxiety, parent negativity, and parent oxytocin levels. Independent-evaluator-reported outcomes were moderated by baseline anxiety. Children assigned to their optimal treatment condition had significantly greater reduction in anxiety symptoms, compared with children assigned to their nonoptimal treatment. Significant interactions emerged between the identified moderators. CONCLUSIONS: Our findings represent an important step toward optimizing treatment selection and increasing treatment efficacy. En ligne : http://dx.doi.org/10.1111/jcpp.13386 Permalink : https://www.cra-rhone-alpes.org/cid/opac_css/index.php?lvl=notice_display&id=456