Cognitive Behavioral Therapy, Sertraline, or a Combination in Childhood Anxiety
By J. Walkup, A. Albano, J. Piacentini, B. Birmaher, S. Compton, J. Sherrill, Golda S. Ginsburg, M. Rynn, James T. McCracken, B. Waslick and 3 more. New England Journal of Medicine, 2008
1,319 citations recorded by the source corpus.
Background Anxiety disorders are common psychiatric conditions affecting children and adolescents. Although cognitive behavioral therapy and selective serotonin-reuptake inhibitors have shown efficacy in treating these disorders, little is known about their relative or combined efficacy. Methods In this randomized, controlled trial, we assigned 488 children between the ages of 7 and 17 years who had a primary diagnosis of separation anxiety disorder, generalized anxiety disorder, or social phobia to receive 14 sessions of cognitive behavioral therapy, sertraline (at a dose of up to 200 mg per day), a combination of sertraline and cognitive behavioral therapy, or a placebo drug for 12 weeks in a 2:2:2:1 ratio. We administered categorical and dimensional ratings of anxiety severity and impairment at baseline and at weeks 4, 8, and 12. Results The percentages of children who were rated as very much or much improved on the Clinician Global Impression-Improvement scale were 80.7% for combination therapy (P<0.001), 59.7% for cognitive behavioral therapy (P<0.001), and 54.9% for sertraline (P<0.001); all therapies were superior to placebo (23.7%). Combination therapy was superior to both monotherapies (P<0.001). Results on the Pediatric Anxiety Rating Scale documented a similar magnitude and pattern of response; combination therapy had a greater response than cognitive behavioral therapy, which was equivalent to sertraline, and all therapies were superior to placebo. Adverse events, including suicidal and homicidal ideation, were no more frequent in the sertraline group than in the placebo group. No child attempted suicide. There was less insomnia, fatigue, sedation, and restlessness associated with cognitive behavioral therapy than with sertraline. Conclusions Both cognitive behavioral therapy and sertraline reduced the severity of anxiety in children with anxiety disorders; a combination of the two therapies had a superior response rate. (ClinicalTrials.gov number, NCT00052078.)
Subfields: Clinical Psychology, Experimental and Cognitive Psychology, Psychiatry and Mental health
View Paper: https://www.semanticscholar.org/paper/a41b3bc19195f9eba51187a6e1119eeb1b17a808
How researchers see this paper
The researchers whose trusted networks rank it highest, strongest advocate first. Every researcher gets a different order.
In Clinical Psychology
In Experimental and Cognitive Psychology
In Psychiatry and Mental health
Citations in the corpus
- Comorbidity of Anxiety and Depression in Children and Adolescents: 20 Years After (2013, neutral): “In some anxietytreatment study designs, such as comparisons to medications where the medication arm may actually target both disorders, depressive disorders are an appropriate exclusion criterion (e.g., Walkup et al., 2008).”
- Beyond simple models of self-control to circuit-based accounts of adolescent behavior. (2015, methodology): “Only half of those individuals with anxiety respond to these treatments (Walkup et al. 2008), and the work highlighted in this review showed diminished fear extinction during adolescence in rodents and humans (McCallum et al. 2010, Pattwell et al. 2012), which suggests that exposure-based therapies…”
- Harnessing neuroplasticity for clinical applications (2011, neutral): “and anxiety disorders, a long tradition of evidence-based cognitive-behaviour therapy is based on the principle of identifying and modifying top-down responses to maladaptive cognition, affect and behaviour (Beck, 2005; Walkup et al., 2008).”
- An Initial Description and Pilot of Group Behavioral Activation Therapy for Anxious and Depressed Youth (2009, methodology): “Based on the satisfaction scale used in the Child/ Adolescent Anxiety Multimodal Study (CAMS; Walkup et al., 2008), the Group Satisfaction Questionnaire (GSQ) is an 8-item child-report measure assessing child satisfaction on a 1 to 4 scale (total range=8–32).”
- Training Therapists in Evidence-Based Practice: A Critical Review of Studies From a Systems-Contextual Perspective (2010, methodology): “Eighty percent was used as the cutoff, consistent with training conditions used in other evaluations of EBP as the criterion to be satisfied prior to being certified to deliver a treatment (e.g., Seng, Prinz, & Sanders, 2006; Sholomaskas et al., 2005; Walkup et al., 2008).”
- Behavior Therapy for Children with Tourette Disorder: A Randomized Controlled Trial (2010, neutral): “Diagnostic eligibility was established with a Diagnostic and Statistical Manual–based, semistructured clinical interview(20) administered separately to parent and child and modified to cover Tourette and other tic disorders.(21) Outcome assessments were repeated at weeks 5 and 10.”
- Parent Training for Childhood Anxiety Disorders: The SPACE Program (2014, background): “Furthermore, many patients decline to participate in treatment altogether (Krebs & Heyman, 2010; Walkup et al., 2008).”
- Canadian clinical practice guidelines for the management of anxiety, posttraumatic stress and obsessive-compulsive disorders (2014, methodology): “The guidelines include panic disorder, agoraphobia, specific phobia, social anxiety disorder (SAD), generalized anxiety disorder (GAD), as well as obsessive-compulsive disorder (OCD), and posttraumatic stress disorder (PTSD).”
- Adaptive Interventions in Child and Adolescent Mental Health (2016, background): “For example, in the Child and Adolescent Anxiety Multimodal Study, 81% of children who were offered sertraline combined with high-quality medication management and highquality CBT were rated as very much or much improved at the end of 12 weeks (Walkup et al., 2008).”