Innovative child and adolescent treatment research for anxiety and depressive disorders

Abstract

‘‘Taking it to the Streets: Advancing the Dissemination of CBT’’ was the theme of the annual meeting of the Association for Behavioral and Cognitive Therapies (ABCT) held in Orlando, Florida in November 2008. ABCT is an interdisciplinary organization comprising researchers, clinicians, and trainees who are committed to development, implementation, and dissemination of behavioral, cognitive, and other evidence-based interventions. Historically, the ABCT annual meetings have had a preponderance of presentations focused on the treatment of anxiety and depressive disorders, and the 2008 meeting was no exception. Below are some of the highlights of this year’s convention. Treatments for childhood anxiety were evaluated in the Child/Adolescent Anxiety Multimodal Treatment Study (CAMS), a multisite National Institute of Mental Health (NIMH)-supported trial comparing the efficacy of cognitive-behavior therapy (CBT), sertraline, pill placebo, and a combination of CBT and sertraline for treating children and adolescents with Generalized Anxiety Disorder, Social Phobia, and/or Separation Anxiety Disorder. Study investigators presented a symposium focused on the primary outcomes of CAMS, the largest (n5 488) and first ever randomized clinical trial for childhood anxiety. Results indicated that the combined intervention led to significantly better response rates than CBT alone or sertraline alone (81% versus 60% and 55%, Po.001), whereas the monotherapies were not significantly different from each other. All three active conditions were superior to pill placebo (23.7% response rate, Po.001). John Walkup, M.D. and colleagues emphasized that clinicians can recommend three options for treating child and adolescent anxiety based on treatment availability and family preferences. Paul Rohde, Ph.D. from the Oregon Research Institute presented the findings of the continuation and maintenance treatments provided in the multisite Treatments of Adolescents with Depression Study (TADS). TADS examined the impact of psychosocial and psychopharmacological interventions on the achievement and maintenance of sustained treatment response for depression, comparing the effectiveness of fluoxetine (FLX), CBT, combination therapy (COMB), and pill placebo with clinical management (PBO). Following 12 weeks of acute treatment, patients in the FLX, CBT, and COMB conditions received 6 weeks of continuation treatment (intensity based on degree of response to acute treatment) followed by three maintenance treatment sessions scheduled over 18 weeks. Patients continued in the same treatment conditions assigned during acute treatment. Among the 39% (n5 95) of patients who had not achieved a sustained response (two consecutive ratings of a full response in assessments conducted 6 weeks apart) at the end of the acute treatment, sustained response rates during continuation and maintenance treatments were as follows: 80% COMB, 62% FLX, and 77% CBT (difference not significant). These results indicate that for most depressed adolescents who do not achieve a sustained response during acute treatment, extra time and treatment will result in the desired treatment effect. Although CAMS and TADS studied treatments for either anxiety or depression, respectively, Robin Weersing, Ph.D. from San Diego State University and University of California, San Diego presented the results of a pilot effectiveness study of a brief, integrated cognitive-behavioral approach to treat children with anxiety and/or depressive disorders in a primary-care setting. The eight-session treatment adapted and combined two CBT protocols, one for anxiety and one for depression, with a focus on ‘‘graded engagement’’ (a combination of exposure and behavioral activation). Children aged 8–17 (n5 60) with diagnoses of depression and/or anxiety were randomized to receive either the brief behavioral treatment or outside referral. Results at 12 weeks indicated that children in the brief CBT condition demonstrated significantly greater clinical global improvement and symptom reduction than children in the control group. Children with comorbid diagnoses demonstrated significant reductions in both anxious and depressive symptoms, suggesting the feasibility of a