Air Fare parents ask me often, "Is there any way to know what actually works to treat my child's anxiety?" The simple answer is 'yes,' but the more complicated answer about how we arrive at 'yes' is a bit more interesting.. To understand the more-complicated answer, it's important to know more about the term 'meta- analysis.. ' A meta-analysis is a large analysis of many studies or analyses - bringing a large amount of data together under strict requirements to look at conclusions more broadly.. About 15 years ago, psychologists Ollendick and King conducted a very influential meta-analysis of evidence-based psychosocial treatments for child and adolescent (referred to as youth from this point forward) anxiety disorders..
They concluded that psychosocial treatments (i. Air Fare. E., cognitive and behavior therapies) were likely effective but that better methods and further research were needed before stronger conclusions were reached.. In the interim years, methods for evaluating treatments have improved dramatically and strong conclusions now support the effectiveness of cognitive behavior therapy (CBT).. This is explained further below, but first let's look at the scope of the problem.. Anxiety disorders are one of the most common disorders in youth. Air Fare. Depending on the report, in the United States between 5%-10% of youth have an anxiety disorder with some studies reporting as high as 20% (ref Silverman).. The same article cites, a study based on surveys in New Zealand and Australia reporting between 3% and 44% of youth have an anxiety disorder! In these studies, the anxiety disorders include separation anxiety/school refusal (sometimes called school phobia), social anxiety, specific phobias (e.
. g., needles, animals, heights, etc.. ), and overanxious/generalized anxiety. Air Fare. Three anxiety disorders together - social anxiety, separation anxiety, and generalized anxiety - make up what clinicians call the 'anxiety triad' and are highly prevalent among youth.. Most youth who have symptoms of one of these disorders often have symptoms of the other two.. Similar prevalence rates in the 3% to 10% range occur for OCD (ref March and Storch, Drew article).. In 1998, Ollendick's and King's meta-analysis showed that behavioral procedures like imaginal (using guided instruction to imagine a real-life event) and in vivo (real life) desensitization (exposure therapy that uses small steps to help the brain turn off alarms related to a specific trigger) were "probably efficacious " (such a cautious statement!) for childhood phobias and that these same procedures were similarly effective with and without family anxiety management training.. Air Fare in 1998, the authors concluded (as researchers are wont to do) - that more research with better methodology was needed.. Thankfully, better studies with better methodologies occurred, producing the updated meta-analysis by Silverman and colleagues and numerous publications about separate, effective OCD treatment for youth by March, Storch, and many others.. Studies included in the meta-analysis by Silverman and her colleagues were categorized from the most rigorous - randomized prospective clinical trials (random assignment, blinded assessments, inclusion/exclusion, adequate sample, state-of-the-science diagnostics, well-established and sound measures with clearly defined interventions and adherence in implementing the intervention).
. These very 'tight' studies are Type 1 studies.. Other studies included ranged from 2, to 6. Air Fare. As the number descended, criticism of methods increased.. For example, studies designated Type 6 were case studies or opinion papers.. The carefully designed studies, which contributed greatly to the conclusions reached, had qualities like strict inclusion/exclusion criteria (for example, youth with low IQ, psychotic disorder, unstable family life, co-occurring mental disorders, and similar characteristics that could affect the viability of a treatment were excluded).. Compared to the tentative conclusions of the 1998 analysis by Ollendick and King, Silverman and her colleagues concluded: "The considerable progress made shows that cognitive behavioral treatments, in individual or group formats, with and without parent involvement lead to positive treatment outcomes in children and adolescents with phobic and anxiety disorders.. Air Fare air Fare " Similar conclusions by March and Storch for OCD, support CBT's effectiveness for all anxiety disorders in youth.. These strong improvements in methodology and treatment study outcomes that support CBT open the way for more-detailed questions about what works in CBT.. Scientists want to further refine information about treatment (e.. g., how much of a treatment is needed specifically, what is it about the treatment that works, what other factors affect whether the treatment works, whether medicine should be included in treatment, which aspects of treatment over what period of time make the most difference, and other similar questions).. From studies of specific aspects of CBT, we know, for example, that it is important to reduce anxious self talk.. Also, a parent's anxiety or depression can negatively affect treatment.. Refining treatment questions (what works/what doesn't) is a good thing because it helps provide better answers for families and more specific direction for treatment providers.. How much treatment, the role played by medications, how to measure precisely, and other methodological issues will occupy researchers for awhile, but it's great as a clinician to be able to offer effective, evidence-based CBT interventions for anxiety disorders in youth...