Different Types and Acceptability of Psychotherapies for Acute Anxiety Disorders in Children and Adolescents: A Network Meta-analysis

Xinyu Zhou, Yuqing Zhang, Toshiaki A. Furukawa, Pim Cuijpers, Juncai Pu, John R. Weisz, Lining Yang, Sarah E. Hetrick, Cinzia Del Giovane, David Cohen, Anthony C. James, Shuai Yuan, Craig Whittington, Xiaofeng Jiang, Teng Teng, Andrea Cipriani, Peng Xie

Research output: Contribution to JournalArticleAcademicpeer-review

Abstract

Importance: Anxiety disorders are common in children and adolescents, and uncertainty remains regarding the optimal strategy of psychotherapies in this population. Objective: To compare and rank the different types of psychotherapies and the different ways of delivering psychological treatments for anxiety disorders in children and adolescents. Data Sources: PubMed, Cochrane Central Register of Controlled Trials, EMBASE, PsycINFO, Web of Science, CINAHL (Cumulative Index to Nursing and Allied Health Literature), ProQuest Dissertations, LILACS (Literatura Latino Americana em Ciências da Saúde), international trial registers, and US Food and Drug Administration reports were searched from inception to November 30, 2017. Study Selection: Randomized clinical trials that compared any structured psychotherapy with another psychotherapy or a control condition for anxiety disorders in children and adolescents were selected. Data Extraction and Synthesis: Four researchers independently performed data extraction and quality assessment. Pairwise meta-analyses and Bayesian network meta-analysis within the random-effects model were used to synthesize data. Main Outcomes and Measures: Efficacy (change in anxiety symptoms) posttreatment and at follow-up, acceptability (all-cause discontinuation), and quality of life and functional improvement were measured. The certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation framework. Results: A total of 101 unique trials including 6625 unique participants compared 11 different psychotherapies with 4 specific control conditions. The certainty of evidence was rated as low or very low for most comparisons. For efficacy, most psychotherapies were significantly more effective than the wait list condition posttreatment (standardized mean difference [SMD], -1.43 to -0.61) and at the longest follow-up (SMD, -1.84 to -1.64). However, only group cognitive behavioral therapy (CBT) was significantly more effective than the other psychotherapies and all control conditions posttreatment. For acceptability, bibliotherapy CBT had significantly more all-cause discontinuations than some psychotherapies and control conditions (range of odds ratios, 2.48-9.32). In terms of quality of life and functional improvement, CBT (delivered in different ways) was significantly beneficial compared with psychological placebo and the wait list condition (SMDs, 0.73 to 1.99). Conclusions and Relevance: Group CBT would be the more appropriate choice of psychotherapy for anxiety disorders in children and adolescents, based on these findings. Other types of psychotherapies and different ways of delivering psychological treatment can be alternative options. Further research is needed to explore specific anxiety disorders, disorder-specific psychotherapy, and moderators of treatment effect.

Original languageEnglish
Pages (from-to)41-50
Number of pages10
JournalJAMA Psychiatry
Volume76
Issue number1
Early online date31 Oct 2018
DOIs
Publication statusPublished - Jan 2019

Fingerprint

Anxiety Disorders
Psychotherapy
Cognitive Therapy
Psychology
Bibliotherapy
Network Meta-Analysis
Quality of Life
Information Storage and Retrieval
United States Food and Drug Administration
Hispanic Americans
PubMed
Uncertainty
Meta-Analysis
Nursing
Therapeutics
Anxiety
Randomized Controlled Trials
Odds Ratio
Placebos
Research Personnel

Cite this

Zhou, Xinyu ; Zhang, Yuqing ; Furukawa, Toshiaki A. ; Cuijpers, Pim ; Pu, Juncai ; Weisz, John R. ; Yang, Lining ; Hetrick, Sarah E. ; Del Giovane, Cinzia ; Cohen, David ; James, Anthony C. ; Yuan, Shuai ; Whittington, Craig ; Jiang, Xiaofeng ; Teng, Teng ; Cipriani, Andrea ; Xie, Peng. / Different Types and Acceptability of Psychotherapies for Acute Anxiety Disorders in Children and Adolescents : A Network Meta-analysis. In: JAMA Psychiatry. 2019 ; Vol. 76, No. 1. pp. 41-50.
@article{2d489d2a32c14a6087f17938231877a7,
title = "Different Types and Acceptability of Psychotherapies for Acute Anxiety Disorders in Children and Adolescents: A Network Meta-analysis",
abstract = "Importance: Anxiety disorders are common in children and adolescents, and uncertainty remains regarding the optimal strategy of psychotherapies in this population. Objective: To compare and rank the different types of psychotherapies and the different ways of delivering psychological treatments for anxiety disorders in children and adolescents. Data Sources: PubMed, Cochrane Central Register of Controlled Trials, EMBASE, PsycINFO, Web of Science, CINAHL (Cumulative Index to Nursing and Allied Health Literature), ProQuest Dissertations, LILACS (Literatura Latino Americana em Ci{\^e}ncias da Sa{\'u}de), international trial registers, and US Food and Drug Administration reports were searched from inception to November 30, 2017. Study Selection: Randomized clinical trials that compared any structured psychotherapy with another psychotherapy or a control condition for anxiety disorders in children and adolescents were selected. Data Extraction and Synthesis: Four researchers independently performed data extraction and quality assessment. Pairwise meta-analyses and Bayesian network meta-analysis within the random-effects model were used to synthesize data. Main Outcomes and Measures: Efficacy (change in anxiety symptoms) posttreatment and at follow-up, acceptability (all-cause discontinuation), and quality of life and functional improvement were measured. The certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation framework. Results: A total of 101 unique trials including 6625 unique participants compared 11 different psychotherapies with 4 specific control conditions. The certainty of evidence was rated as low or very low for most comparisons. For efficacy, most psychotherapies were significantly more effective than the wait list condition posttreatment (standardized mean difference [SMD], -1.43 to -0.61) and at the longest follow-up (SMD, -1.84 to -1.64). However, only group cognitive behavioral therapy (CBT) was significantly more effective than the other psychotherapies and all control conditions posttreatment. For acceptability, bibliotherapy CBT had significantly more all-cause discontinuations than some psychotherapies and control conditions (range of odds ratios, 2.48-9.32). In terms of quality of life and functional improvement, CBT (delivered in different ways) was significantly beneficial compared with psychological placebo and the wait list condition (SMDs, 0.73 to 1.99). Conclusions and Relevance: Group CBT would be the more appropriate choice of psychotherapy for anxiety disorders in children and adolescents, based on these findings. Other types of psychotherapies and different ways of delivering psychological treatment can be alternative options. Further research is needed to explore specific anxiety disorders, disorder-specific psychotherapy, and moderators of treatment effect.",
author = "Xinyu Zhou and Yuqing Zhang and Furukawa, {Toshiaki A.} and Pim Cuijpers and Juncai Pu and Weisz, {John R.} and Lining Yang and Hetrick, {Sarah E.} and {Del Giovane}, Cinzia and David Cohen and James, {Anthony C.} and Shuai Yuan and Craig Whittington and Xiaofeng Jiang and Teng Teng and Andrea Cipriani and Peng Xie",
year = "2019",
month = "1",
doi = "10.1001/jamapsychiatry.2018.3070",
language = "English",
volume = "76",
pages = "41--50",
journal = "JAMA Psychiatry",
issn = "2168-622X",
publisher = "American Medical Association",
number = "1",

}

Zhou, X, Zhang, Y, Furukawa, TA, Cuijpers, P, Pu, J, Weisz, JR, Yang, L, Hetrick, SE, Del Giovane, C, Cohen, D, James, AC, Yuan, S, Whittington, C, Jiang, X, Teng, T, Cipriani, A & Xie, P 2019, 'Different Types and Acceptability of Psychotherapies for Acute Anxiety Disorders in Children and Adolescents: A Network Meta-analysis' JAMA Psychiatry, vol. 76, no. 1, pp. 41-50. https://doi.org/10.1001/jamapsychiatry.2018.3070

Different Types and Acceptability of Psychotherapies for Acute Anxiety Disorders in Children and Adolescents : A Network Meta-analysis. / Zhou, Xinyu; Zhang, Yuqing; Furukawa, Toshiaki A.; Cuijpers, Pim; Pu, Juncai; Weisz, John R.; Yang, Lining; Hetrick, Sarah E.; Del Giovane, Cinzia; Cohen, David; James, Anthony C.; Yuan, Shuai; Whittington, Craig; Jiang, Xiaofeng; Teng, Teng; Cipriani, Andrea; Xie, Peng.

In: JAMA Psychiatry, Vol. 76, No. 1, 01.2019, p. 41-50.

Research output: Contribution to JournalArticleAcademicpeer-review

TY - JOUR

T1 - Different Types and Acceptability of Psychotherapies for Acute Anxiety Disorders in Children and Adolescents

T2 - A Network Meta-analysis

AU - Zhou, Xinyu

AU - Zhang, Yuqing

AU - Furukawa, Toshiaki A.

AU - Cuijpers, Pim

AU - Pu, Juncai

AU - Weisz, John R.

AU - Yang, Lining

AU - Hetrick, Sarah E.

AU - Del Giovane, Cinzia

AU - Cohen, David

AU - James, Anthony C.

AU - Yuan, Shuai

AU - Whittington, Craig

AU - Jiang, Xiaofeng

AU - Teng, Teng

AU - Cipriani, Andrea

AU - Xie, Peng

PY - 2019/1

Y1 - 2019/1

N2 - Importance: Anxiety disorders are common in children and adolescents, and uncertainty remains regarding the optimal strategy of psychotherapies in this population. Objective: To compare and rank the different types of psychotherapies and the different ways of delivering psychological treatments for anxiety disorders in children and adolescents. Data Sources: PubMed, Cochrane Central Register of Controlled Trials, EMBASE, PsycINFO, Web of Science, CINAHL (Cumulative Index to Nursing and Allied Health Literature), ProQuest Dissertations, LILACS (Literatura Latino Americana em Ciências da Saúde), international trial registers, and US Food and Drug Administration reports were searched from inception to November 30, 2017. Study Selection: Randomized clinical trials that compared any structured psychotherapy with another psychotherapy or a control condition for anxiety disorders in children and adolescents were selected. Data Extraction and Synthesis: Four researchers independently performed data extraction and quality assessment. Pairwise meta-analyses and Bayesian network meta-analysis within the random-effects model were used to synthesize data. Main Outcomes and Measures: Efficacy (change in anxiety symptoms) posttreatment and at follow-up, acceptability (all-cause discontinuation), and quality of life and functional improvement were measured. The certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation framework. Results: A total of 101 unique trials including 6625 unique participants compared 11 different psychotherapies with 4 specific control conditions. The certainty of evidence was rated as low or very low for most comparisons. For efficacy, most psychotherapies were significantly more effective than the wait list condition posttreatment (standardized mean difference [SMD], -1.43 to -0.61) and at the longest follow-up (SMD, -1.84 to -1.64). However, only group cognitive behavioral therapy (CBT) was significantly more effective than the other psychotherapies and all control conditions posttreatment. For acceptability, bibliotherapy CBT had significantly more all-cause discontinuations than some psychotherapies and control conditions (range of odds ratios, 2.48-9.32). In terms of quality of life and functional improvement, CBT (delivered in different ways) was significantly beneficial compared with psychological placebo and the wait list condition (SMDs, 0.73 to 1.99). Conclusions and Relevance: Group CBT would be the more appropriate choice of psychotherapy for anxiety disorders in children and adolescents, based on these findings. Other types of psychotherapies and different ways of delivering psychological treatment can be alternative options. Further research is needed to explore specific anxiety disorders, disorder-specific psychotherapy, and moderators of treatment effect.

AB - Importance: Anxiety disorders are common in children and adolescents, and uncertainty remains regarding the optimal strategy of psychotherapies in this population. Objective: To compare and rank the different types of psychotherapies and the different ways of delivering psychological treatments for anxiety disorders in children and adolescents. Data Sources: PubMed, Cochrane Central Register of Controlled Trials, EMBASE, PsycINFO, Web of Science, CINAHL (Cumulative Index to Nursing and Allied Health Literature), ProQuest Dissertations, LILACS (Literatura Latino Americana em Ciências da Saúde), international trial registers, and US Food and Drug Administration reports were searched from inception to November 30, 2017. Study Selection: Randomized clinical trials that compared any structured psychotherapy with another psychotherapy or a control condition for anxiety disorders in children and adolescents were selected. Data Extraction and Synthesis: Four researchers independently performed data extraction and quality assessment. Pairwise meta-analyses and Bayesian network meta-analysis within the random-effects model were used to synthesize data. Main Outcomes and Measures: Efficacy (change in anxiety symptoms) posttreatment and at follow-up, acceptability (all-cause discontinuation), and quality of life and functional improvement were measured. The certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation framework. Results: A total of 101 unique trials including 6625 unique participants compared 11 different psychotherapies with 4 specific control conditions. The certainty of evidence was rated as low or very low for most comparisons. For efficacy, most psychotherapies were significantly more effective than the wait list condition posttreatment (standardized mean difference [SMD], -1.43 to -0.61) and at the longest follow-up (SMD, -1.84 to -1.64). However, only group cognitive behavioral therapy (CBT) was significantly more effective than the other psychotherapies and all control conditions posttreatment. For acceptability, bibliotherapy CBT had significantly more all-cause discontinuations than some psychotherapies and control conditions (range of odds ratios, 2.48-9.32). In terms of quality of life and functional improvement, CBT (delivered in different ways) was significantly beneficial compared with psychological placebo and the wait list condition (SMDs, 0.73 to 1.99). Conclusions and Relevance: Group CBT would be the more appropriate choice of psychotherapy for anxiety disorders in children and adolescents, based on these findings. Other types of psychotherapies and different ways of delivering psychological treatment can be alternative options. Further research is needed to explore specific anxiety disorders, disorder-specific psychotherapy, and moderators of treatment effect.

UR - http://www.scopus.com/inward/record.url?scp=85056133466&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85056133466&partnerID=8YFLogxK

U2 - 10.1001/jamapsychiatry.2018.3070

DO - 10.1001/jamapsychiatry.2018.3070

M3 - Article

VL - 76

SP - 41

EP - 50

JO - JAMA Psychiatry

JF - JAMA Psychiatry

SN - 2168-622X

IS - 1

ER -