Treatment that combines a certain type of psychotherapy with an antidepressant medication is most likely to help children with anxiety disorders,
but each of the treatments alone is also effective, according to a new
study funded by the National Institutes of Health’s National Institute
of Mental Health (NIMH). The study was published online Oct. 30,
2008, in the New England Journal of Medicine.
“Anxiety
disorders are among the most common mental disorders affecting children
and adolescents. Untreated anxiety can undermine a child’s success in
school, jeopardize his or her relationships with family, and inhibit
social functioning,” said NIMH Director Thomas R. Insel, M.D. “This
study provides strong evidence and reassurance to parents that a
well-designed, two-pronged treatment approach is the gold standard,
while a single line of treatment is still effective.”
The
Child/Adolescent Anxiety Multimodal Study (CAMS) randomly assigned 488
children ages 7 years to 17 years to one of four treatment options for
a 12-week period:
- Cognitive behavioral therapy (CBT), a
specific type of therapy that, for this study, taught children about
anxiety and helped them face and master their fears by guiding them
through structured tasks;
- The antidepressant sertraline (Zoloft), a selective serotonin reuptake inhibitor (SSRI);
- CBT combined with sertraline;
- pill placebo (sugar pill).
The
children, recruited from six regionally dispersed sites throughout the
United States, all had moderate to severe separation anxiety disorder,
generalized anxiety disorder or social phobia. Many also had coexisting
disorders, including other anxiety disorders, attention deficit
hyperactivity disorder, and behavior problems.
John Walkup, M.D.,
of Johns Hopkins Medical Institutions, and colleagues found that among
those in combination treatment, 81 percent improved. Sixty percent in
the CBT-only group improved, and 55 percent in the sertraline-only
group improved. Among those on placebo, 24 percent improved. A second
phase of the study will monitor the children for an additional six
months.
“CAMS clearly showed that combination treatment is the
most effective for these children. But sertraline alone or CBT alone
showed a good response rate as well. This suggests that clinicians and
families have three good options to consider for young people with
anxiety disorders, depending on treatment availability and costs,” said
Walkup.
Results also showed that the treatments were safe.
Children taking sertraline alone showed no more side effects than the
children taking the placebo and few children discontinued the trial due
to side effects. In addition, no child attempted suicide, a rare side
effect sometimes associated with antidepressant medications in children.
CAMS
findings echo previous studies in which sertraline and other SSRIs were
found to be effective in treating childhood anxiety disorder. The
study’s results also add more evidence that high-quality CBT, with or
without medication, can effectively treat anxiety disorders in
children, according to the researchers.
“Further analyses of the
CAMS data may help us predict who is most likely to respond to which
treatment, and develop more personalized treatment approaches for
children with anxiety disorders,” concluded Philip C. Kendall,
Ph.D., of Temple University, a senior investigator of the study. “But
in the meantime, we can be assured that we already have good treatments
at our disposal.”
The six CAMS sites were Duke University; New
York State Psychiatric Institute/Columbia University Medical Center;
Johns Hopkins University; Temple University/University of Pennsylvania;
University of California, Los Angeles; and the Western Psychiatric
Institute and Clinic/University of Pittsburgh Medical Center.
Reference
Walkup
JT, Albano AM, Piacentini J, Birmaher B, Compton SN, Sherrill J,
Ginsburg GS, Rynn MA, McCracken J, Waslick B, Iyengar S, March JS,
Kendall PC. Cognitive-behavioral therapy, sertraline and their
combination for children and adolescents with anxiety disorders: acute
phase efficacy and safety. New England Journal of Medicine. Online
ahead of print 30 Oct 2008.
Fourteen Great Books on Anxiety Disorders:
- What
to Do When You Worry Too Much: A Kid's Guide to Overcoming Anxiety
(What to Do Guides for Kids) by Dawn Huebner and Bonnie Matthews
(Paperback - Sep 2005)
-
Overcoming Generalized Anxiety Disorder - Client Manual: A Relaxation,
Cognitive Restructuring, and Exposure-Based Protocol for the Treatment
of GAD (Best Practices for Therapy) by John White (Paperback - Jan 1,
1999)
-
Overcoming Anxiety for Dummies (Paperback) by Laura L. Smith (Author), Charles H. Elliott (Author)
-
The Anxiety & Phobia Workbook, Fourth Edition (Paperback) by Edmund J. Bourne
-
Overcoming Anxiety: From Short-Time Fixes to Long-Term Recovery (Paperback) by Reneau Peuifov
Overcoming Social Anxiety and Shyness Self-help Course (Overcoming) by Gillian Butler (Paperback - Aug 30, 2007)
-
Free Yourself from Fears: Overcoming Anxiety and Living Without Worry by Joseph O'Connor (Paperback - Sep 25, 2005)
-
Overcoming Panic, Anxiety, & Phobias: New Strategies to Free
Yourself from Worry and Fear by Carol Goldman and Shirley Babior
(Paperback - Jan 1996)
-
If Your Adolescent Has an Anxiety Disorder: An Essential Resource for
Parents (Adolescent Mental Health Initiative) by Edna B. Foa and Linda
Wasmer Andrews (Paperback - April 1, 2006)
-
Overcoming Anxiety: A Self Help Guide Using Cognitive Behavioral
Techniques (Overcoming) by Helen Kennerley (Paperback - Feb 1, 1997)
-
Panic and Anxiety Disorder: 121 Tips, Real-life Advice, Resources &
More, Second Edition by Linda Manassee Buell and Brenda K., Ph.D.
Wiederhold (Paperback - May 1, 2003)
-
Living Fully with Shyness and Social Anxiety: A Comprehensive Guide to
Gaining Social Confidence by Erika B. Hilliard (Paperback - April 11,
2005)
-
Your Life is Waiting: The Average Joe's Guide to Overcoming Panic
Attacks and Anxiety by Rafe R. Martin (Kindle Edition - Nov 6, 2007) -
Kindle Book
-
Overcoming Social Anxiety and Shyness: A Self-Help Guide Using
Cognitive Behavioral Techniques (Overcoming) by Gillian Butler
(Paperback - May 12, 2008)
-
Overcoming Anxiety: Panic Attacks and Anxiety Disorders (Health Body,
Healthy Soul Series) by David Hazard (Paperback - Sep 2003)
Thirteen Resource and Support Groups for Anxiety Disorders:
- Anxiety Friends
- Anxiety Zone
- Yahoo Anxiety Support Groups
- BP Panic
- MDJunction
- Center for Emotional Wellbeing
- Social Anxiety Anonymous
- The Anxiety Community
- Yahoo Panic Support Groups
- Anxiety Disorders Association of America
- Anxiety Connection.com
- Google Anxiety Support Groups
- Social Anxiety Support
Additional Resources:
- For related articles on
anxiety disorders on the Web, click on: “Sphere: Related Content” located
at the bottom of this blog post.
- For related books or blog posts with related content in Dr. Jeff’s and Dr. Tanya’s Blog, go to “Psychiatric Disorders: Anxiety” or type in the keyword “anxiety disorders” into “Google Search” located in the sidebar.
- For related articles from Psychology Today,
click on the “Psychology Today” banner in the side bar and type in the
keyword, “anxiety disorders” into the Psychology Today “Search”.
- For more books with related
content, click any hyperlinked keyword in the blog or type in the keyword,
“anxiety disorders” into “Amazon Search” on the Amazon banner located in
the side bar.
Sources: National Institute of Mental Health, Also see blogposts in: Psychiatric Disorders: Anxiety Disorders
Dr. Jeffrey Speller
Dr. Tanya Korkosz
Psychopharmacology Associates of New England
www.psychopharmassociates.com
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