Summary: Researchers report a single intervention may not be helpful for young people with anxiety in the long term.
No matter which treatment they get, only 20 percent of young people diagnosed with anxiety will stay well over the long term, UConn Health researchers report in the Journal of the American Academy of Child and Adolescent Psychiatry.
“When you see so few kids stay non-symptomatic after receiving the best treatments we have, that’s discouraging,” says UConn Health psychologist Golda Ginsburg. She suggests that regular mental health checkups may be a better way to treat anxiety than the current model.
The study followed 319 young people aged 10 to 25 who had been diagnosed with separation, social, or general anxiety disorders at sites in California, North Carolina, Maryland, and Pennsylvania. They received evidence-based treatment with either sertraline (the generic form of Zoloft) or cognitive behavioral therapy or a combination of these two, and then had follow-ups with the researchers every year for four years. The follow-ups assessed anxiety levels but did not provide treatment. Other studies have done a single follow-up at one, two, five, or 10 years out, but those were essentially snapshots in time. This is the first study to reassess youth treated for anxiety every year for four years.
The sequential follow-ups meant that the researchers could identify people who relapsed, recovered, and relapsed again, as well as people who stayed anxious and people who stayed well. They found that 20 percent of patients got well after treatment and stayed well, rating low on anxiety at each follow-up. But about half the patients relapsed at least once, and 30 percent were chronically anxious, meeting the diagnostic criteria for an anxiety disorder at every follow-up. Females were more likely to be chronically ill than males. Other predictors of chronic illness were experiencing more negative life events, having poor family communication, and having a diagnosis of social phobia.
On the bright side, the study found that young people who responded to treatment were more likely to stay well. The study also found no difference in long-term outcomes between treatment types. This means that if there is no cognitive behavioral therapist nearby, treatment with medication is just as likely to be effective.
The study also found that kids did better if their families were supportive and had positive communication styles. And Ginsburg has advice for getting the best help for your child: talk to your child and to the therapist, and ask questions. Why do you suggest this treatment (it should be supported by evidence)? Has the therapist been trained in cognitive behavioral therapy? How can we reinforce what you learned in therapy this week? But also, be aware that a single intervention may not be enough.
“If we can get them well, how do we keep them well?” says Ginsburg. “We need a different model for mental health, one that includes regular checkups.”
About this neuroscience research article
Source: Kim Krieger – UConn Publisher: Organized by NeuroscienceNews.com. Image Source: NeuroscienceNews.com image is adapted from the UConn news release. Original Research:Abstract for “Results From the Child/Adolescent Anxiety Extended Long-Term Study (CAMELS): Primary Anxiety Outcomes” by Golda S. Ginsburg, PhD, Emily M. Becker-Haimes, PhD, Courtney Keeton, PhD, Philip C. Kendall, PhD, ABPP, Satish Iyengar, PhD, Dara Sakolsky, MD, Anne Marie Albano, PhD, Tara Peris, PhD, Scott N. Compton, PhD, John Piacentini, PhD, ABPP in Journal of the American Academy of Child and Adolescent Psychiatry. Published May 3 2018. doi:10.1016/j.jaac.2018.03.017
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[cbtabs][cbtab title=”MLA”]UConn “Single Intervention Not Enough For Anxiety.” NeuroscienceNews. NeuroscienceNews, 30 May 2018. <https://neurosciencenews.com/anxiety-intervention-9194/>.[/cbtab][cbtab title=”APA”]UConn (2018, May 30). Single Intervention Not Enough For Anxiety. NeuroscienceNews. Retrieved May 30, 2018 from https://neurosciencenews.com/anxiety-intervention-9194/[/cbtab][cbtab title=”Chicago”]UConn “Single Intervention Not Enough For Anxiety.” https://neurosciencenews.com/anxiety-intervention-9194/ (accessed May 30, 2018).[/cbtab][/cbtabs]
Results From the Child/Adolescent Anxiety Extended Long-Term Study (CAMELS): Primary Anxiety Outcomes
Objective To report anxiety outcomes from the multisite Child/Adolescent Anxiety Multi-modal Extended Long-term Study (CAMELS). Rates of stable anxiety remission (defined rigorously as the absence of all DSM-IV TR anxiety disorders across all follow-up years) and predictors of anxiety remission across a 4-year period, beginning 4 to 12 years after randomization to 12 weeks of medication, cognitive behavioral therapy (CBT), their combination, or pill placebo were examined. Examined predictors of remission included acute treatment response, treatment assignment, baseline child and family variables, and interim negative life events.
Method Data were from 319 youths (age range 10.9−25.2 years; mean age 17.12 years) originally diagnosed with separation, social, and/or generalized anxiety disorders and enrolled in the multi-site Child/Adolescent Anxiety Multimodal Study (CAMS). Participants were assessed annually by independent evaluators using the age-appropriate version of the Anxiety Disorders Interview Schedule and completed questionnaires (e.g., about family functioning, life events, and mental health service use).
Results Almost 22% of youth were in stable remission, 30% were chronically ill, and 48% were relapsers. Acute treatment responders were less likely to be in the chronically ill group (odds ratio = 2.73; confidence interval = 1.14−6.54; p < .02); treatment type was not associated with remission status across the follow-up. Several variables (e.g., male gender) predicted stable remission from anxiety disorders.
Conclusion Findings suggest that acute positive response to anxiety treatment may reduce risk for chronic anxiety disability; identified predictors can help tailor treatments to youth at greatest risk for chronic illness.
Clinical Trial Registration Information Child and Adolescent Anxiety Disorders (CAMS). http://clinicaltrials.gov/; NCT00052078.