Types of parental involvement in CBT with anxious youth: a preliminary meta-analysis.
OBJECTIVE
Meta-analytic studies have not confirmed that involving parents in cognitive behavior therapy (CBT) for anxious children is therapeutically beneficial. There is also great heterogeneity in the type of parental involvement included. We investigated parental involvement focused on contingency management (CM) and transfer of control (TC) as a potential outcome moderator using a meta-analysis with individual patient data.


METHODS
Investigators of randomized controlled trials (RCTs) of CBT for anxious children, identified systematically, were invited to submit their data. Conditions in each RCT were coded based on type of parental involvement in CBT (i.e., low involvement, active involvement without emphasis on CM or TC, active involvement with emphasis on CM or TC). Treatment outcomes were compared using a 1-stage meta-analysis.


RESULTS
All cases involved in active treatment (894 of 1,618) were included for subgroup analyses. Across all CBT groups, means of clinical severity, anxiety, and internalizing symptoms significantly decreased posttreatment and were comparable across groups. The group without emphasis on CM or TC showed a higher proportion with posttreatment anxiety diagnoses than the low-involvement group. Between posttreatment and 1-year follow-up, the proportion with anxiety diagnoses significantly decreased in CBT with active parental involvement with emphasis on CM or TC, whereas treatment gains were merely maintained in the other 2 groups.


CONCLUSIONS
CBT for anxious children is an effective treatment with or without active parental involvement. However, CBT with active parental involvement emphasizing CM or TC may support long-term maintenance of treatment gains. RESULTS should be replicated as additional RCTs are published.
Department of Psychiatry.
Katharina
K
Manassis
Faculty of Medicine, University of Toronto.
Trevor Changgun
TC
Lee
McMaster University.
Kathryn
K
Bennett
Biostatistics, Design, and Analysis Unit, Hospital for Sick Children.
Xiu Yan
XY
Zhao
Department of Psychiatry, Hospital for Sick Children.
Sandra
S
Mendlowitz
Clinical Epidemiology and Biostatistics, McMaster University.
Stephanie
S
Duda
Faculty of Social Work, University of Toronto.
Michael
M
Saini
Department of Psychiatry, University of Toronto.
Pamela
P
Wilansky
Department of Psychiatry, University of British Columbia.
Susan
S
Baer
Pathways Health and Research Centre, West End.
Paula
P
Barrett
University of Utrecht.
Denise
D
Bodden
School of Psychology, University of Queensland.
Vanessa E
VE
Cobham
School of Psychology, University of New South Wales.
Mark R
MR
Dadds
University of Rhode Island.
Ellen
E
Flannery-Schroeder
Johns Hopkins University School of Medicine.
Golda
G
Ginsburg
Leiden University.
David
D
Heyne
Department of Psychology, Macquarie University.
Jennifer L
JL
Hudson
Department of Psychology, Temple University.
Philip C
PC
Kendall
Leiden University.
Juliette
J
Liber
Department of Psychology, William Paterson University.
Carrie
C
Masia-Warner
University of Groningen.
Maaike H
MH
Nauta
Department of Psychology, Macquarie University.
Ronald M
RM
Rapee
Department of Psychiatry, Yale University.
Wendy
W
Silverman
Children's Center for OCD and Anxiety.
Lynne
L
Siqueland
Griffith University.
Susan H
SH
Spence
Erasmus Medical Center Sophia-Children's Hospital.
Elisabeth
E
Utens
Department of Psychiatry, University of California.
Jeffrey J
JJ
Wood
D000293:Adolescent; D001007:Anxiety / Q000523:psychology / Q000628:therapy*; D001008:Anxiety Disorders / Q000523:psychology / Q000628:therapy*; D002648:Child; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D005196:Family Therapy; D005260:Female; D006801:Humans; D008297:Male; D010290:Parents / Q000523:psychology; D016032:Randomized Controlled Trials as Topic; D012720:Severity of Illness Index; D016896:Treatment Outcome