A Randomized Controlled Effectiveness Study Comparing Manualized Cognitive Behavioral Therapy (CBT) with Treatment-As-Usual for Clinically Anxious Children

Objective: CBT is an empirically supported treatment for childhood anxiety disorders. However, it has been rarely tested in real-world clinical practice or compared to treatment-as-usual (TAU). Method: The present study was a randomized controlled trial (RCT) comparing manualized CBT with TAU in Dutch mental health centers for clinically referred anxious children (N=88) aged 7-13 years. Treatment predictors included therapeutic alliance and parenting. Assessment took place at baseline, post-treatment, 6 and 12 months after treatment, and consisted of child-reports of anxiety, therapeutic alliance, and parenting; and mother-reports of children’s anxiety, children’s problem behavior, and parenting. Results: Both groups benefitted significantly from treatment with medium to large effect sizes, for mother- and child-reported outcomes. CBT was not superior to TAU on primary or secondary outcomes. TAU was even superior to CBT in some instances. Treatment gains were maintained at follow-ups. Therapeutic alliance and parenting did not predict treatment outcome. Conclusions: Manualized CBT did not produce better treatment outcomes than usual treatment within routine clinical practice. Findings suggest that CBT can be effective in a shorter and more flexible manner. More research is needed to identify which children profit best from which treatment.