Hostname: page-component-8448b6f56d-dnltx Total loading time: 0 Render date: 2024-04-25T04:53:34.751Z Has data issue: false hasContentIssue false
  • English
  • Français

Effectiveness and long-term stability of outpatient cognitive behavioural therapy (CBT) for children and adolescents with anxiety and depressive disorders under routine care conditions

Published online by Cambridge University Press:  13 March 2023

Daniel Walter ,
Ulrike Behrendt ,
Eva Katharina Matthias Open the ORCID record for Eva Katharina Matthias [Opens in a new window] ,
Martin Hellmich ,
Lydia Dachs ,
Hildegard Goletz ,
Anja Goertz-Dorten ,
Daniela Perri ,
Christiane Rademacher  and
Stephanie Schuermann
...Show all authors
Daniel Walter*
Affiliation:
Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Robert-Koch-Str. 10, 50931 Cologne, Germany School of Child and Adolescent Cognitive Behavior Therapy (AKiP), Faculty of Medicine and University Hospital Cologne, University of Cologne, Pohligstr. 9, 50969 Cologne, Germany
Ulrike Behrendt
Affiliation:
School of Child and Adolescent Cognitive Behavior Therapy (AKiP), Faculty of Medicine and University Hospital Cologne, University of Cologne, Pohligstr. 9, 50969 Cologne, Germany
Eva Katharina Matthias
Affiliation:
School of Child and Adolescent Cognitive Behavior Therapy (AKiP), Faculty of Medicine and University Hospital Cologne, University of Cologne, Pohligstr. 9, 50969 Cologne, Germany
Martin Hellmich
Affiliation:
Institute for Medical Statistics and Computational Biology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
Lydia Dachs
Affiliation:
School of Child and Adolescent Cognitive Behavior Therapy (AKiP), Faculty of Medicine and University Hospital Cologne, University of Cologne, Pohligstr. 9, 50969 Cologne, Germany
Hildegard Goletz
Affiliation:
School of Child and Adolescent Cognitive Behavior Therapy (AKiP), Faculty of Medicine and University Hospital Cologne, University of Cologne, Pohligstr. 9, 50969 Cologne, Germany
Anja Goertz-Dorten
Affiliation:
Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Robert-Koch-Str. 10, 50931 Cologne, Germany School of Child and Adolescent Cognitive Behavior Therapy (AKiP), Faculty of Medicine and University Hospital Cologne, University of Cologne, Pohligstr. 9, 50969 Cologne, Germany
Daniela Perri
Affiliation:
School of Child and Adolescent Cognitive Behavior Therapy (AKiP), Faculty of Medicine and University Hospital Cologne, University of Cologne, Pohligstr. 9, 50969 Cologne, Germany
Christiane Rademacher
Affiliation:
Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Robert-Koch-Str. 10, 50931 Cologne, Germany School of Child and Adolescent Cognitive Behavior Therapy (AKiP), Faculty of Medicine and University Hospital Cologne, University of Cologne, Pohligstr. 9, 50969 Cologne, Germany
Stephanie Schuermann
Affiliation:
Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Robert-Koch-Str. 10, 50931 Cologne, Germany School of Child and Adolescent Cognitive Behavior Therapy (AKiP), Faculty of Medicine and University Hospital Cologne, University of Cologne, Pohligstr. 9, 50969 Cologne, Germany
Katrin Woitecki
Affiliation:
School of Child and Adolescent Cognitive Behavior Therapy (AKiP), Faculty of Medicine and University Hospital Cologne, University of Cologne, Pohligstr. 9, 50969 Cologne, Germany
Tanja Wolff Metternich-Kaizman
Affiliation:
Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Robert-Koch-Str. 10, 50931 Cologne, Germany School of Child and Adolescent Cognitive Behavior Therapy (AKiP), Faculty of Medicine and University Hospital Cologne, University of Cologne, Pohligstr. 9, 50969 Cologne, Germany
Manfred Doepfner
Affiliation:
Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Robert-Koch-Str. 10, 50931 Cologne, Germany School of Child and Adolescent Cognitive Behavior Therapy (AKiP), Faculty of Medicine and University Hospital Cologne, University of Cologne, Pohligstr. 9, 50969 Cologne, Germany
*
*Corresponding author. Email: daniel.walter@uk-koeln.de
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

Randomised controlled trials (RCTs) have provided considerable evidence for the short-term efficacy of cognitive behavioural therapy (CBT) in children and adolescents with depressive and anxiety disorders. However, the effectiveness and long-term stability of treatment effects under routine care conditions remain unproven.

Aims:

This observational study investigates the effectiveness and stability of CBT under routine care conditions within a large sample of clinically referred youth with depressive and anxiety disorders.

Method:

Two hundred and twenty former patients (age 6–18 years at start of treatment) underwent a follow-up assessment (follow-up interval: M=5.3 years, SD=2.47). Parent and self-ratings of behavioural and emotional problems were obtained at the beginning and end of treatment and at follow-up. Additionally, at follow-up, a telephone interview and questionnaires exploring other mental symptoms and life satisfaction were administered.

Results:

A repeated measures ANOVA yielded statistically significant, medium to large pre– post symptom reductions (ηp 2=.15 to ηp²=.47) and small to medium post-follow-up symptom reductions (ηp²=.03 to ηp²=.19). At follow-up, between 57 and 70% of the sample reported a decrease in different emotional symptoms since the end of treatment, and 80% reported improved life satisfaction.

Conclusions:

These findings provide evidence for the effectiveness and stability of treatment effects of CBT in youth with depressive and anxiety disorders under routine care conditions. Due to the lack of a direct control condition and a substantial proportion of missing data, the results must be interpreted with caution.

Keywords

child and adolescent psychotherapycognitive behavioural therapyinternalising disordersroutine treatment
Type
Main
Information
Behavioural and Cognitive Psychotherapy , Volume 51 , Issue 4 , July 2023 , pp. 320 - 334
Copyright
© The Author(s), 2023. Published by Cambridge University Press on behalf of British Association for Behavioural and Cognitive Psychotherapies

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Bear, H., Edbrooke-Childs, J., Norton, S., Krause, K., & Wolpert, M. (2019). Systematic review and meta-analysis: outcomes of routine specialist mental health care for young people with depression and/or anxiety. Journal of the American Academy of Child and Adolescent Psychiatry, 59, 810–841.CrossRefGoogle ScholarPubMed
Beesdo, K., Knappe, S., & Pine, D. S. (2009). Anxiety and anxiety disorders in children and adolescents: developmental issues and implications for DSM-V [Review]. Psychiatric Clinics of North America, 32, 483–524. https://doi.org/10.1016/j.psc.2009.06.002 CrossRefGoogle ScholarPubMed
Busner, J., & Targum, S. D. (2007). The Clinical Global Impressions Scale: applying a research tool in clinical practice. Psychiatry, 4, 28–37.Google ScholarPubMed
Carr, A. (2009). What Works with Children, Adolescents and Adults? A Review of Research on the Effectiveness of Psychotherapy. Routledge.Google Scholar
Cohen, J. (1988). Statistical Power Analysis for the Behavioral Sciences (2nd edn). Erlbaum.Google Scholar
de Lijster, J. M., Dieleman, G. C., Utens, E., Dierckx, B., Wierenga, M., Verhulst, F. C., & Legerstee, J. S. (2018). Social and academic functioning in adolescents with anxiety disorders: a systematic review. Journal of Affective Disorders, 230, 108–117. https://doi.org/10.1016/j.jad.2018.01.008 CrossRefGoogle ScholarPubMed
Doepfner, M., & Goertz-Dorten, A. (2017). DISYPS-III. Diagnostik-System für psychische Störungen nach ICD-10 und DSM-V für Kinder und Jugendliche - III [DISYPS-III: Diagnostic system for psychiatric disorders in children and adolescents]. Hogrefe.Google Scholar
Doepfner, M., Goertz-Dorten, A., & Lehmkuhl, G. (2009). Diagnostik-System für psychische Störungen nach ICD-10 und DSM-IV für Kinder und Jugendliche-II: DISYPS-II; Manual. Huber, Hogrefe.Google Scholar
Doepfner, M., Plueck, J., Berner, W., Fegert, J., Huss, M., Lenz, K., …, & Lehmkuhl, G. (1997). Psychische Auffälligkeiten von Kindern und Jugendlichen in Deutschland - Ergebnisse einer repräsentativen Studie: Methodik, Alters-, Geschlechts- und Beurteilereffekte [Mental disturbances in children and adolescents in Germany. Results of a representative study: age, gender and rater effects]. Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie, 25, 218–233.Google Scholar
Doepfner, M., Plueck, J., Kinnen, C., & Arbeitsgruppe Deutsche Child Behavior Checklist (2014). Manual deutsche Schulalter-Formen der Child Behavior Checklist von Thomas M. Achenbach. Elternfragebogen über das Verhalten von Kindern und Jugendlichen (CBCL/6-18R), Lehrerfragebogen über das Verhalten von Kindern und Jugendlichen (TRF/6-18R), Fragebogen für Jugendliche (YSR/11-18R) [Manual of the German versions of the Child Behavior Checklist for school-aged children and adolescents by Thomas M. Achenbach. Child Behavior Checklist (CBCL/6-18R), Teacher Report Form (TRF/6-18R), Youth Self Report (YSR/11-18R)]. Hogrefe.Google Scholar
Doepfner, M., & Steinhausen, H. C. (2012). Störungsübergreifende Verfahren zur Diagnostik psychischer Störungen [Transdiagnostic instruments to assess mental health disorders]. Hogrefe.Google Scholar
Eckshtain, D., Kuppens, S., Ugueto, A., Ng, M. Y., Vaughn-Coaxum, R., Corteselli, K., & Weisz, J. R. (2020). Meta-analysis: 13-year follow-up of psychotherapy effects on youth depression. Journal of the American Academy of Child and Adolescent Psychiatry, 59, 45–63. https://doi.org/10.1016/j.jaac.2019.04.002 CrossRefGoogle ScholarPubMed
Erskine, H. E., Baxter, A. J., Patton, G., Moffitt, T. E., Patel, V., Whiteford, H. A., & Scott, J. G. (2017). The global coverage of prevalence data for mental disorders in children and adolescents. Epidemiology and Psychiatric Sciences, 26, 395–402. https://doi.org/10.1017/S2045796015001158 CrossRefGoogle ScholarPubMed
Fahrenberg, J., Myrtek, M., Schumacher, J., & Braehler, E. (2000). Fragebogen zur Lebenszufriedenheit (FLZ). Handanweisung. Hogrefe.Google Scholar
Franke, G. H. (2017). BSCL-53®-S. Brief Symptom-Checklist–Standard–Deutsches Manual. Hogrefe.Google Scholar
Higa-McMillan, C. K., Francis, S. E., Rith-Najarian, L., & Chorpita, B. F. (2016). Evidence base update: 50 years of research on treatment for child and adolescent anxiety. Journal of Clinical Child and Adolescent Psychology, 45, 91–113. https://doi.org/10.1080/15374416.2015.1046177 CrossRefGoogle ScholarPubMed
Jacobson, N. S., & Truax, P. (1991). Clinical significance: a statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology, 59, 12–19.10.1037/0022-006X.59.1.12CrossRefGoogle ScholarPubMed
James, A. C., James, G., Cowdrey, F. A., Soler, A., & Choke, A. (2015). Cognitive behavioural therapy for anxiety disorders in children and adolescents. Cochrane Database of Systematic Reviews (2), CD004690. https://doi.org/10.1002/14651858.CD004690.pub4 CrossRefGoogle Scholar
Keppel, G. (1991). Design and Analysis: A Researcher’s Handbook. Prentice-Hall, Inc.Google Scholar
Kreuze, L. J., Pijnenborg, G. H. M., de Jonge, Y. B., & Nauta, M. H. (2018). Cognitive-behavior therapy for children and adolescents with anxiety disorders: a meta-analysis of secondary outcomes. Journal of Anxiety Disorders, 60, 43–57. https://doi.org/10.1016/j.janxdis.2018.10.005 CrossRefGoogle ScholarPubMed
Lachin, J. (2015). Fallacies of last observation carried forward analyses. Clinical Trials. https://doi.org/https://doi.org/10.1177/1740774515602688 CrossRefGoogle Scholar
Lee, C. M., Horvath, C., & Hunsley, J. (2013). Does it work in the real world? The effectiveness of treatments for psychological problems in children and adolescents. Professional Psychology: Research and Practice, 44, 81.10.1037/a0031133CrossRefGoogle Scholar
Lepine, J. P., & Briley, M. (2011). The increasing burden of depression. Neuropsychiatric Disease and Treatment, 7 (suppl 1), 3–7. https://doi.org/10.2147/NDT.S19617 Google ScholarPubMed
Mahdi, M., Jhawar, S., Benett, S.D., & Shafran, R. (2018). Cognitive behavioral therapy for childhood anxiety disorders: what happens to comorbid mood and behavioral disorders? A systematic review. Journal of Affective Disorders, 251, 141–148.10.1016/j.jad.2019.03.041CrossRefGoogle Scholar
Mahmoud, J. S., Staten, R. T., Hall, L. A., & Lennie, T. A. (2012). The relationship among young adlts college students’ depression, anxiety, stress, demographics, life satisfaction, and coping styles. Issues in Mental Health Nursing, 33, 149–156.10.3109/01612840.2011.632708CrossRefGoogle Scholar
McAleavey, A. A., Youn, S. J., Xiao, H., Castonguay, L. G., Hayes, J. A., & Locke, B. D. (2019). Effectiveness of routine psychotherapy: method matters. Psychotherapy Research, 29, 139–156. https://doi.org/10.1080/10503307.2017.1395921 CrossRefGoogle ScholarPubMed
Meule, A., & Voderholzer, U. (2020). Life satisfaction in persons with mental disorders. Quality of Life Research, 29, 3043–3052. https://doi.org/10.1007/s11136-020-02556-9 CrossRefGoogle ScholarPubMed
Naicker, K., Galambos, N. L., Zeng, Y., Senthilselvan, A., & Colman, I. (2013). Social, demographic, and health outcomes in the 10 years following adolescent depression. Journal of Adolescent Health, 52, 533–538. https://doi.org/10.1016/j.jadohealth.2012.12.016 CrossRefGoogle ScholarPubMed
National Institute for Health and Care Excellence (NICE) (2014). Anxiety Disorders. https://www.nice.org.uk/guidance/qs53 Google Scholar
National Institute for Health and Care Excellence (NICE) (2019). Depression in Children and Young People: Identification and Management. https://www.nice.org.uk/guidance/NG134 Google Scholar
Newgard, C., & Lewis, R. (2015). MIssing data – how to best account for what is not known. Clinical Review & Education, 314, 940–941.Google Scholar
Pella, J. E., Slade, E. P., Pikulski, P. J., & Ginsburg, G. S. (2020). Pediatric anxiety disorders: a cost of illness analysis. Journal of Abnormal Child Psychology, 48, 551–559. https://doi.org/10.1007/s10802-020-00626-7 CrossRefGoogle ScholarPubMed
Reynolds, S., Wilson, C., Austin, J., & Hooper, L. (2012). Effects of psychotherapy for anxiety in children and adolescents: a meta-analytic review. Clinical Psychology Reviews, 32, 251–262. https://doi.org/10.1016/j.cpr.2012.01.005 CrossRefGoogle ScholarPubMed
Rissanen, T., Viinamäki, H., Honkalampi, K., Lehto, S. M., MHintikka, J., Saharinen, T., & Koivumaa-Honkanen, H. (2011). Long term life dissatisfaction and subsequent major depressive disorder and poor mental health. BMC Psychiatry, 11, 1–6.10.1186/1471-244X-11-140CrossRefGoogle ScholarPubMed
Roest, S. L., Siebelink, B. M., van Ewijk, H., Vermeiren, R., Middeldorp, C. M., & van der Lans, R. M. (2021). Sociodemographic and clinical characteristics in child and youth mental health; comparison of routine outcome measurements of an Australian and Dutch outpatient cohort. Epidemiology and Psychiatric Sciences, 30, e74. https://doi.org/10.1017/S2045796021000652 CrossRefGoogle ScholarPubMed
Rubin, D. B. (1987). Multiple Imputation for Survey Nonresponse. New York: Wiley.CrossRefGoogle Scholar
Ssegonja, R., Alaie, I., Philipson, A., Hagberg, L., Sampaio, F., Moller, M., …, & Feldman, I. (2019). Depressive disorders in adolescence, recurrence in early adulthood, and healthcare usage in mid-adulthood: a longitudinal cost-of-illness study. Journal of Affective Disorders, 258, 33–41. https://doi.org/10.1016/j.jad.2019.07.077 CrossRefGoogle ScholarPubMed
Van Buuren, S. (2018). Flexible Imputation of Missing Data. CRC press.CrossRefGoogle Scholar
Vitiello, B., & Ordóñez, A. E. (2016). Pharmacological treatment of children and adolescents with depression. Expert Opinion on Pharmacotherapy, 17, 2273–2279. https://doi.org/10.1080/14656566.2016.1244530 CrossRefGoogle ScholarPubMed
Weersing, V., & Weisz, J. (2002). Community clinic treatment of depressed youth: benchmarking usual care against CBT clinical trials. Journal of Consulting and Clinical Psychology, 70, 299–310.CrossRefGoogle ScholarPubMed
Weersing, V. R., Jeffreys, M., Do, M. T., Schwartz, K. T., & Bolano, C. (2017). Evidence base update of psychosocial treatments for child and adolescent depression. Journal of Clinical Child and Adolescent Psychology, 46, 11–43. https://doi.org/10.1080/15374416.2016.1220310 CrossRefGoogle ScholarPubMed
Weisz, J. R., Doss, A. J., & Hawley, K. M. (2005). Youth psychotherapy outcome research: a review and critique of the evidence base. Annual Review of Psychology, 56, 337–363.CrossRefGoogle ScholarPubMed
Weisz, J. R., Kuppens, S., Ng, M. Y., Eckshtain, D., Ugueto, A. M., Vaughn-Coaxum, R., …, Fordwood, S. R. (2017). What five decades of research tells us about the effects of youth psychological therapy: a multilevel meta-analysis and implications for science and practice. American Psychologist, 72, 79–117. https://doi.org/10.1037/a0040360 CrossRefGoogle ScholarPubMed
Weisz, J. R., Ugueto, A. M., Cheron, D. M., & Herren, J. (2013). Evidence-based youth psychotherapy in the mental health ecosystem. Journal of Clinical Child and Adolescent Psychology, 42, 274–286.CrossRefGoogle ScholarPubMed
Weitz, E., Kleiboer, A., van Straten, A., & Cuijpers, P. (2018). The effects of psychotherapy for depression on anxiety symptoms: a meta-analysis. Psychological Medicine, 48, 2140–2152. https://doi.org/10.1017/S0033291717003622 CrossRefGoogle ScholarPubMed
Wergeland, G. J. H., Riise, E. N., & Ost, L. G. (2021). Cognitive behavior therapy for internalizing disorders in children and adolescents in routine clinical care: a systematic review and meta-analysis. Clinical Psychology Reviews, 83, 101918. https://doi.org/10.1016/j.cpr.2020.101918 CrossRefGoogle Scholar
World Health Organization (1996). Multiaxial Classification of Child and Adolescent Psychiatric Disorders: The ICD-10 Classification of Mental and Behavioural Disorders in Children and Adolescents. Cambridge: Cambridge University Press.Google Scholar
Supplementary material: File

Walter et al. supplementary material

Tables S1 and S2

Download Walter et al. supplementary material(File)
File 21.7 KB
Submit a response

Comments

No Comments have been published for this article.