Abstract
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, clinicaltrials.gov/ct2/show/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.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 492-502 |
| Number of pages | 11 |
| Journal | Journal of Child Psychology and Psychiatry and Allied Disciplines |
| Volume | 61 |
| Issue number | 4 |
| DOIs | |
| State | Published - Apr 1 2020 |
Funding
Funding awarded to M.C. from L.J. Bo?thius Foundation, Lindhaga Foundation, The Sven Jerring Foundation, and Region Sk?ne made possible data analysis for and drafting of the present manuscript. CAMS was funded by the NIMH?(MH063747 to P.C.K.; MH64003 to B.B.; MH64003 to S.N.C.; MH64107 to March; MH64088 to J.P.; MH64089 to J.T.W.; MH64092 to A.M.A.).?The funding sources had no role in study design, data collection, analysis and interpretation of the data, or drafting or revision of the manuscript. E.A.S. is a consultant for Levo Therapeutics. E.A.S. receives grant funding from Greater Houston Community Foundation, Red Cross, ReBuild Texas, NIH, and Texas Higher Education Coordinating Board. E.A.S. receives book royalties from Springer, Elsevier, Wiley, APA, and Lawrence Erlbaum. J.P. has received grant or research support from NIMH, the TLC Foundation for Body-focused Repetitive Behaviors, the Tourette Association of America, and Pfizer Pharmaceuticals through the Duke University Clinical Research Institute Network. J.P. receives publication royalties from Guilford Press and Oxford University Press. J.P. has served on the speakers? bureau of the Tourette Association of America, the International Obsessive Compulsive Disorder Foundation, and the TLC Foundation for Body-focused Repetitive Behaviors. B.B. reports receiving research funding from the NIMH and royalties for publications from UptoDate, APA, and Random House. S.N.C. receives research support from the National Institute of Health, NC GlaxoSmithKline Foundation and is currently a consultant for Mursion, Inc and Luminopia, Inc. S.N.C. has also been a consultant for Shire, received honoraria from the Journal of Consulting and Clinical Psychology, Nordic Long-Term OCD Treatment Study Research Group, and the Centre for Child and Adolescent Mental Health, Eastern and Southern Norway. S.N.C. serves on the scientific advisory board of Tourette's Association of American, Anxiety and Depression Association of America, and Mursion, Inc. S.N.C. has given expert testimony for Duke University. A.M.A. receives an Editor's honorarium from the Society for Clinical Child and Adolescent Psychology and royalties from Oxford University Press. J.T.W. reports receiving research funding from Hartwell Foundation and Tourette Syndrome Association and book royalties from Oxford University Press and Guilford Press. P.C.K. reports receiving author royalties from the sales of treatment materials (Guilford, Oxford University Press, and Workbook Publishing). The spouse of P.C.K. has a financial interest in and is affiliated with Workbook Publishing. The remaining authors have declared that they have no competing or potential conflicts of interest.?The authors would like to thank the reviewers for suggesting the overall NIA model.
Keywords
- CBT/cognitive behavior therapy
- anxiety/anxiety disorders
- child/adolescent
- clinical trials
- pharmacotherapy
ASJC Scopus subject areas
- Pediatrics, Perinatology, and Child Health
- Developmental and Educational Psychology
- Psychiatry and Mental health