Nfhk2011 jon bjåstad_parallel21


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Effectiveness of CBT for anxiety disorders in mental health clinics and in schools as indicated prevent. Jon Bjåstad et al. Anxiety Disorders Research Network, Haukeland University Hospital, Norway

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Nfhk2011 jon bjåstad_parallel21

  1. 1. Effectiveness of CBT for anxietydisorders in mental health clinics and in schools as indicated prevention Bjåstad JF1, Wergeland GJH1,2, Høye, A3, Fjermestad KW1,2, Haugland B1,4, Oeding, K1, Öst LG 1,5, Havik O 1,2, Heiervang ER, 1,6. 1 Anxiety Disorders Research Network, Haukeland University Hospital, Norway 2 University of Bergen, Norway 3 Fjell Municipality, Norway 4 Uni Research, Norway 5 Stockholm University, Sweden 6 University of Oslo, Norway
  2. 2. Background• The effect of CBT for childhood anxiety disorders is well documented in university clinic settings• Results may not be valid in regular outpatients clinics – Recruited vs referred children – Homogenous sample – Differences in therapist training• Few effectiveness studies in clinical settings• Few effectiveness studies on the use of CBT as indicative prevention in the school health system
  3. 3. Study questions:1. Is ”FRIENDS for life” effective for the treatment of anxiety for children and adolescents in an outpatient setting?2. Is ”FRIENDS for life” effective as an indicated prevention program in a school/youth health center setting?
  4. 4. Assessment and Treatment- Anxiety inChildren and Adults (ATACA) A randomized, controlled, multisite, effectiveness study of the CBT programme ”Friends for life”. PI Einar R. Heiervang, Professor PI Odd E. Havik, Professor Grant from Western Norway Regional Health Trust
  5. 5. Study sites No of clinics: 7 No of therapists: 16 No of assessors: 16
  6. 6. Methods Participants • 8-15 year olds, ordinary referrals with a primary anxiety disorder diagnosis
  7. 7. MethodsInclusion/Exclusion• Inclusion – Separation (SAD), Social (SOP), or Generalised (GAD) anxiety disorder. (ADIS-C/P; CSR>=4)• Exclusion – Autism spectrum disorder – Intellectual disabilities – Obsessive-compulsive disorder – Severe conduct problems – Unstable medication
  8. 8. MethodsIntervention• Friends for Life, 4th ed (Barrett; 2004, 2005) – Group and Individual format – Child (8-12) and Youth (12-15) versions F - feeling worried ? R - relax and feel good I - inner thoughts E - explore plans N - nice work so reward yourself D - don’t forget to practice S - stay calm, you know how to cope now
  9. 9. MethodsMeasures• Anxiety Disorders Interview Schedule – (ADIS IV-C/P; Silverman & Albano, 1996)• Spence Children’s Anxiety Scale – (SCAS; Spence, 1995)• Short Mood and Feelings Questionnaire – (SMFQ; Angold et al., 1995)
  10. 10. Sample characteristics Total sample N=182 M (SD) %Gender Male 47,0 % Female 53,0 %Age (mean, SD) 11.54 (2.08)Age group 8-12 yrs 66,0 % 12-15 yrs 34,0 %Comorbidity present 77,5 %Primary diagnosis SAD 33,0 % SOP 46,0 % GAD 21,0 %
  11. 11. Is ”FRIENDS for life” effective for the treatment of anxiety for children andadolescents in an outpatient setting? Results
  12. 12. Active treatment vs wait list80,0 %70,0 %60,0 %50,0 % 43,3 %40,0 % Post treatment After Wait list 31,1 %30,0 %20,0 % 13,9 %10,0 % 2,8 % 0,0 % No longer primary diagnosis No anxiety diagnosis
  13. 13. Group- vs individual treatment100 %90 %80 %70 %60 % 50 %50 % Group40 % 38 % 38 % Individual30 % 25 %20 %10 % 0% No longer primary diagnosis No anxietydiagnosis
  14. 14. Diagnostic Recovery Rates• By age – Children 41% – Adolescents 38%• No statistically significant differences with respect to age group/treatment format an diagnostic recovery rates
  15. 15. SCAS and SMFQ• Moderate effect sizes found for – SCAS self-report – SCAS parent report• Moderate effect sizes found for – SMFQ self report – SMFQ parent report• No statistically significant differences between ICBT and GCBT on SCAS and SMFQ
  16. 16. Conclusions• CBT is effective in the treatment of anxiety with children and adolescents in ordinary outpatient clinics.• No significant effect found for treatment format post-treatment (group versus individual).• Dropout rate lower than in ordinary outpatient clinics.
  17. 17. An early school-based group intervention foryouths with anxiety and depressionsymptoms A study of the CBT programme ”Friends for life”. in Fjell Municipality, Norway
  18. 18. Methods Participants • 36 children/ adolescents from 8 schools with anxiety and/or depression symptoms • Ages 8-15 yrs old (M= 11.8) • 12 boys and 24 girls Recruitment • Recruited through contact with the school health-service or psychologist working in the municipality
  19. 19. Methods Measures • Spence Children Anxiety Scale; SCAS (Spence,1998). • The Mood & Feelings Questionnarie; MFQ (Costello & Angold, 1988). • The Strength and Difficulties Questionnarie; SDQ (Goodman,1997).
  20. 20. Methods Design • Open non-randomization study. • Included 3 months follow up (only child report) Intervention groups • Total of 4 ”FRIENDS for life” groups • 2 in primary school, 1 in secondary school and 1 at a Youth Health Centre.
  21. 21. SCAS 40 35 30SCAS total Score 25 20 Parents 15 Children 10 5 0 Pre Post 3 mnt
  22. 22. MFQ 25 20MFQ total score 15 Parents 10 Children 5 0 Pre Post 3 mnt
  23. 23. Conclusions• The “FRIENDS for life” program was effective in reducing anxiety and depression symptoms in this sample• The children and adolescents reported that they liked participating in the groups, and dropout-rate was low (8%).• The school health service can be an important arena for implementing CBT as indicated prevention
  24. 24. Implications• ”FRIENDS for life” is effective in regular mental health clinics and as an indicated prevention program in the school health service system.
  25. 25. Limitations• Preliminary results• Limited sample size• No follow up
  26. 26. Thank youemail:
  27. 27. Project Group – ATACA study• Einar R. Heiervang, Professor, University of Oslo• Odd E. Havik, Professor, Institute of Clinical Psychology, University of Bergen.• Bente S. Haugland, Dr. Psychol. Centre for Child and Adolescent Metal Health, Western Norway• Kristin Oeding, Cand. Psychol. Institute of Clinical Psychology, University of Bergen• Gerd Kvale, Professor, Institute of Clinical Psychology, University of Bergen.• Jon F. Bjåstad, Doctor of Clinical Psychology, Clinical supervisor• Gro Janne H. Wergeland, Cand. Med., PhD-student, Insitute of Clinical Medicin, University of Bergen.• Krister W. Fjermestad, Cand. Psychol, PhD- student, Institute of Clinical Psychology, University of Bergen.• Lars G. Öst, Professor, Institute of Clinical Psychology, University of Bergen/ Stockholm University.• Robert Goodman, MD PhD, professor, Institute of Psychiatry, Kings College London.
  28. 28. Timeframe ATACA study: Child part 2007 2008 2010 2015 Clinical trials Main study 182 pts End of 5 year Instruments inclusion included follow-up Pilot Last treatment assessment by 02/2011. 2006 2011Organization End of 1 year Design follow-upRecruitment assessment
  29. 29. Flow Chart Invited N=258 Assessed for eligibility N=222 Enrollment N= 182 Randomisation Group Individual WL N= 38 N=77 N= 67 Assessment and Post-treatment assessment re- randomisation Group N= Individual 21 N= 14 Post-treatment assessment 1-year follow-up assessment 5-year follow-up assessment