Childhood anxiety disorders are quite common and associated with significant psychosocial impairment and distress. Offering equivalent efficacy to pharmacotherapy without the common side effect profile, cognitive behavioral therapy (CBT) is a first line treatment for anxiety disorders in youth. However, dissemination of CBT to community settings is very limited. Effective treatment via traditional CBT often necessitates that the patient travel to a center that specializes in this treatment, and cost can prove an impediment to those of lower socioeconomic status, in particular. As well, differing theoretical approaches and training result in a minority of children with anxiety receiving evidence-based CBT. Accordingly, there is a great need for more widely accessible practices. As such, we are proposing a two phase trial that evaluates the feasibility of implementing a patient-centered intervention in community mental health centers, followed by an efficacy trial. In Phase I, an open trial of computerized CBT (CCBT) will be completed that focuses on feasibility issues of providing this intervention in community mental health centers. Thereafter, we will complete a randomized controlled trial comparing CCBT to treatment as usual (TAU). The open trial will recruit 18 youth ages 7 to 13 years, with the purpose of testing both practicality and management of an already developed CCBT protocol (Kendall &Khanna, 2010). The outcome trial will recruit 110 youth accounting for attrition, with the purpose of measuring the efficacy of the CCBT protocol in front-line settings. Significantly greater symptom reductions in the CCBT group as compared to the TAU group would provide critical evidence for the inclusion of CCBT as a treatment option for anxious youth without immediate access to such in-person care. While this study will be coordinated by the University of South Florida Rothman Center for Neuropsychiatry team, recruitment will take place at three community mental health centers throughout Florida that serve families of lower socioeconomic status. Dr. Andel from the College of Behavioral and Community Sciences at the University of South Florida will provide data management services. Primary outcomes will be assessed by an independent evaluator, and will include change in anxiety symptom severity;response rates;and remission rates. CCBT will follow the Kendall and Khanna (2008b) manual with appropriate integrity checks. The implications of this study are significant, as computerized CBT may enable widespread dissemination of efficacious therapy for childhood anxiety disorders.

Public Health Relevance

Childhood anxiety disorders affect a significant percentage of youth, causing substantial distress and impairment. Cognitive behavioral therapy (CBT) is the gold standard treatment for youth with an anxiety disorder but its dissemination to community mental health settings is limited. Thus, we propose to evaluate the feasibility and preliminary efficacy of disseminating a computerized CBT protocol to community mental health centers. An efficacious computer delivered CBT protocol could contribute to public health efforts to address the mental health needs of a large number of children diagnosed with anxiety disorders.

National Institute of Health (NIH)
Agency for Healthcare Research and Quality (AHRQ)
Research Demonstration and Dissemination Projects (R18)
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Health Care Quality and Effectiveness Research (HQER)
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Nunley, Angela
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University of South Florida
Schools of Medicine
United States
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Lewin, Adam B; Wu, Monica S; McGuire, Joseph F et al. (2014) Cognitive behavior therapy for obsessive-compulsive and related disorders. Psychiatr Clin North Am 37:415-45