Intensive treatments for children and adolescents with anxiety or obsessive-compulsive disorders: a systematic review and meta-analysis

<p>Anxiety and obsessive-compulsive disorders have a significant negative impact on youth. Cognitive behavioural therapy (CBT) is recommended and established as effective first-step treatment, but persistent symptoms and non-response are common. Intensive psychological treatments deliver more...

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Bibliographic Details
Main Authors: Ganzevoort, COW, Wolters, LH, Hornstra, R, Grieve, CM, Højgaard, DRMA, Skarphedinsson, GA, Weidle, B, Bertie, L-A, Tomlinson, M, Waite, P, Nauta, MH
Format: Journal article
Language:English
Published: Elsevier 2024
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Summary:<p>Anxiety and obsessive-compulsive disorders have a significant negative impact on youth. Cognitive behavioural therapy (CBT) is recommended and established as effective first-step treatment, but persistent symptoms and non-response are common. Intensive psychological treatments deliver more or longer sessions over a shorter time span, with fewer session gaps. However, an understanding of their effectiveness, characteristics, acceptability, and feasibility is lacking. Systematically searching five databases yielded four controlled and 36 uncontrolled studies (<em>N</em>=2707) involving youth with primary anxiety or obsessive-compulsive disorders, many of whom received prior treatments. Intensive treatments were acceptable and feasible, with low drop-out rates. Between-group analyses compared intensive treatment with standard treatment (<em>k =</em>&nbsp;2) or waitlist (<em>k =</em>&nbsp;2), revealing no significant post-treatment differences in symptom severity or remission. Uncontrolled within-group analyses of intensive treatments showed large improvements from pre- to post-treatment in symptoms (<em>k</em>&nbsp;= 47), remission (<em>k</em>&nbsp;= 17), impairment (<em>k</em>&nbsp;= 22), functioning (<em>k</em>&nbsp;= 5), and quality of life (<em>k</em>&nbsp;= 2), with larger effects at follow-ups. Intensive treatments show promise for youth with anxiety or obsessive-compulsive disorders by potentially offering high treatment completion rates and comparable outcomes to standard CBT, aiding earlier recovery and reducing overall suffering. This systematic review/meta-analysis provides a comprehensive overview of intensive treatments, their theoretical considerations, and empirical findings. Future RCTs should compare the effectiveness of standard and intensive treatments and identify optimal populations for their use.</p>