Effectiveness of a family-focused cognitive-behaviour therapy relative to treatment as usual for anxiety-disordered children and adolescents.

The study compared 2 experimental conditions, namely (1) treatment as usual at the Mater Day Program; and (2) treatment as usual plus the family-oriented CBT anxiety intervention (further details below). The family-oriented CBT intervention was offered in alternating terms to enable quasi-randomisation. All families who attended the Day Program with a child (aged 6 - 18) who met criteria for an anxiety diagnosis on the parent version of the Anxiety Disorders Interview Schedule for Children (ADIS-C; Silverman and Nelles, 1988) with a severity level of 4 or greater were invited to participate in the study. Day Program staff were trained in administration of the ADIS-C by the principal investigator, who had extensive experience with the interview and numerous teaching videos which were used in the training. 20% of all interviews were videotaped and judged independently to determine inter-rater reliability for pre-treatment diagnoses. Attendance was monitored informally by clinicians, however, adherence was not consistently monitored throughout the intervention (identified limitation). Families were randomly assigned to one of the two treatment condition based on the term in which the patient began in the Day Program. Families in the treatment as usual condition received the treatment that all Day Program patients routinely receive. This typically incorporated a combination of case management sessions, individual therapy sessions, parent support sessions, family therapy sessions, and a program of group work for the patient. Families in the family-oriented CBT condition received all of the abovementioned TAU services, in addition to the 'Do as I do' (Cobham, 2006) parent-focused programme and the 'Facing your Fears' (Cobham, 2006a) child/adolescent-focused programme. The FCBT intervention was delivered in parallel to TAU (however TAU extended beyond the 12-week CBT intervention). Both the 'Do As I Do' and 'Facing Your Fears' programmes are manualised programs which have been evaluated in prior efficacy trials. In these programs, parents and children are given workbooks that are used in session and for home-based tasks. The family-oriented CBT intervention consisted of weekly face-to-face groups which were facilitated at the Day Program at the Mater Children's Hospital in Brisbane, Queensland. The intervention programme consisted of 12 weekly sessions, with each session lasting 60-90 minutes. The first 6 sessions were devoted to teaching parents the basic cognitive behavioural principles of anxiety management, as well as strategies for managing their children's anxiety. The subsequent 6 sessions focused on teaching children and adolescents cognitive behavioural principles for managing their own anxiety (focusing on exposure to address anxious avoidance and a "scientific approach" to evaluating the validity of anxiety-provoking thoughts). Approximately 1-month post-intervention, children were invited to return for a booster session where strategies and skills learned within the family intervention were collaboratively reviewed and areas of concern were addressed using cognitive-behavioural strategies. Each booster session lasted for 60 - 90 minutes. The intervention was facilitated by the Principal Investigator (Clinical Psychologist) and one other Day Program staff member who was trained in the treatment of complex mental health conditions in child and adolescent populations.