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Stepped Care Cognitive Behavioural Therapy for Children with Anxiety Disorders: A New Treatment Approach

Published online by Cambridge University Press:  08 October 2010

Adelinde J. M. van der Leeden ,
Brigit M. van Widenfelt ,
Rien van der Leeden ,
Juliette M. Liber ,
Elisabeth M. W. J. Utens  and
Philip D. A. Treffers
Adelinde J. M. van der Leeden*
Affiliation:
Curium-LUMC, Leiden UniversityMedical Center, The Netherlands
Brigit M. van Widenfelt
Affiliation:
Curium-LUMC, Leiden UniversityMedical Center, The Netherlands
Rien van der Leeden
Affiliation:
Institute of Psychology, Leiden University, The Netherlands
Juliette M. Liber
Affiliation:
Curium-LUMC, Leiden UniversityMedical Center, The Netherlands
Elisabeth M. W. J. Utens
Affiliation:
Erasmus Medical Center-Sophia, Rotterdam, The Netherlands
Philip D. A. Treffers
Affiliation:
Curium-LUMC, Leiden UniversityMedical Center, The Netherlands
*
Reprint requests to Adelinde van der Leeden, Curium-LUMC, Academic Center for Child and Adolescent Psychiatry, Endegeesterstraatweg 27, Oegstgeest 2342 AK, The Netherlands. E-mail: A.J.M.van.der.Leeden@umail.leidenuniv.nl
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Abstract

Background: The current nonrandomized clinical trial explored changes over time in children with an anxiety disorder during stepped care, manual-based cognitive behaviour therapy (CBT). Methods: Clinically anxious children (8–12 years, n = 133) and their parents participated in child focused CBT (10 sessions). If assessments indicated additional treatment was necessary, participants could step up to a second and possibly third treatment phase (each 5 sessions) including more parental involvement. Results: After the first treatment phase 45% of the Intention-To-Treat sample was free of any anxiety disorder; after the second and third phase an additional 17% and 11% respectively. In total, 74% of the children no longer met criteria for any anxiety disorder following treatment. Child and parent reported anxiety and depression symptoms of children improved significantly during all treatment phases, as well as child reported anxiety sensitivity and negative affect. Children participating in more treatment showed significant improvements during additional treatment phases, indicating that late change occurred for the subgroup that had not changed during the first phase. Conclusions: Stepped care offers a standardized, assessment based, yet tailored treatment approach for children with anxiety disorders. A more intensive treatment is offered when initial CBT is insufficient, providing children additional opportunities to reach the desired outcome.

Keywords

Stepped carecognitive behaviour therapychildhood anxiety disorders
Type
Research Article
Information
Behavioural and Cognitive Psychotherapy , Volume 39 , Issue 1 , January 2011 , pp. 55 - 75
Copyright
Copyright © British Association for Behavioural and Cognitive Psychotherapies 2010

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References

Notes

Utens, E. M. W. J. and Ferdinand, R. F. (2000). Nederlandse vertaling van de Multidimensional Anxiety Scale for Children (MASC-NL) [Dutch translation of the Multidimensional Anxiety Scale for Children]. Unpublished manuscript, Erasmus-MC Sophia, Rotterdam, The Netherlands.Google Scholar
Koot, H. and van Widenfelt, B. M. (2000). Nederlandse vertaling en betrouwbaarheid van de Children's Depression Inventory [Dutch translation and reliability of the Children's Depression Inventory]. Unpublished manuscript, Curium-LUMC, Leiden, The Netherlands.Google Scholar
van Widenfelt, B. M. and Treffers, P. D. A. (2000). Vertaling van de Negative Affect Self-Statement Questionnaire [Dutch Translation of the Negative Affect Self-Statement Questionnaire]. Unpublished manuscript, Curium-LUMC, Leiden, The Netherlands.Google Scholar
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