Journal
JOURNAL OF CHILD PSYCHOLOGY AND PSYCHIATRY
Volume 61, Issue 4, Pages 492-502Publisher
WILEY
DOI: 10.1111/jcpp.13124
Keywords
CBT; cognitive behavior therapy; anxiety; anxiety disorders; pharmacotherapy; clinical trials; child; adolescent
Categories
Funding
- L.J. Boethius Foundation
- Lindhaga Foundation
- The Sven Jerring Foundation
- Region Skane - NIMH [MH063747, MH64003, MH64107, MH64088, MH64089, MH64092]
- Greater Houston Community Foundation
- NIH
- Texas Higher Education Coordinating Board
- NIMH
- TLC Foundation for Body-focused Repetitive Behaviors
- Tourette Association of America
- Pfizer Pharmaceuticals through the Duke University Clinical Research Institute Network
- Oxford University Press
- International Obsessive Compulsive Disorder Foundation
- National Institute of Health, NC GlaxoSmithKline Foundation
- Luminopia, Inc.
- Nordic Long-Term OCD Treatment Study Research Group
- Centre for Child and Adolescent Mental Health, Eastern and Southern Norway
- Tourette's Association of American, Anxiety and Depression Association of America
- Society for Clinical Child and Adolescent Psychology
- Hartwell Foundation
- Tourette Syndrome Association
- Mursion, Inc
- Red Cross
- ReBuild Texas
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Background Pediatric anxiety disorders are highly prevalent and associated with significant functional disabilities and lifelong morbidity. Cognitive-behavioral therapy (CBT), sertraline, and their combination are effective treatments, but little is known about how these treatments exert their effects. Methods Using network intervention analysis (NIA), we analyzed data from the largest randomized controlled treatment trial of pediatric anxiety disorders (Child/Adolescent Anxiety Multimodal Study, NCT00052078, ) and outlined the causal symptom domain-specific effects of CBT, sertraline, and their combination over the course of the 12-week treatment while taking into account both specificity and overlap between symptom domains. Results All active treatments produced positive effects with the most pronounced and consistent effects emerging in relation to psychological distress, family interference, and avoidance. Psychological distress was consistently the most and physical symptoms the least central symptom domain in the disorder network. Conclusions All active treatments showed beneficial effects when compared to placebo, and NIA identified that these effects were exerted similarly across treatments and primarily through a reduction of psychological distress, family interference, and avoidance. CBT and sertraline may have differential mechanisms of action in relation to psychological distress. Given the lack of causal effects on interference outside family and physical symptoms, interventions tailored to target these domains may aid in the building of more effective treatments. Psychological distress and avoidance should remain key treatment focuses because of their central roles in the disorder network. The findings inform and promote developing more effective interventions.
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