Study Shows Poor Outcomes for the Treatment for Childhood Anxiety

New research identifies poor long-term outcomes for both CBT and medications for treating anxiety disorders in childhood

Sadie Cathcart
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In a study published this month in the Journal of the American Academy of Child & Adolescent Psychiatry, researchers explored the long-term effects of four treatment conditions over time for children who met the diagnostic criteria for social, generalized, and separation anxiety disorder. Their findings indicate that, despite promising immediate posttreatment effects, participant outcomes got worse each year across all treatment conditions. Less than half of study participants met criteria for stable remission over the next five years posttreatment, and less than a quarter were “consistently ‘anxiety free’ (absence of all anxiety disorders) over the course of the follow-up.” In essence, despite exposure to high-quality, evidence-based interventions, the vast majority of participants experienced significant anxiety in the years that followed treatment.

The study authors, Dr. Golda Ginsburg of the University of Connecticut School of Medicine and a team of researchers representing seven other research institutions, present this data as an extension of the Child/Adolescent Anxiety Multimodal Extended Long-term Study (CAMELS), which compared differences between the effects of 12-week courses of CBT, medication, a combination of both, and a placebo condition directly following treatment. The current study assessed rates of stable anxiety remission and predictors of anxiety remission over a five-year period following the completion of one of the treatments mentioned above.

“Data examining the long-term outcomes of treated youth can provide important information about downstream anxiety disability and estimates and expectations for prognosis to families,” the authors write. “These data can also inform possible preventive efforts.”

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Anxiety during childhood is increasingly prevalent. Some studies have indicated CBT and medication have had the sustained, long-term effect of reducing anxiety. However, such studies have primarily explored impacts at only one point in time in the years following treatment, instead of exploring effects at multiple time points.

Increased adverse childhood experiences (ACEs), increased academic expectations imposed, Common Core curriculum initiatives, and the general emphasis in schools on teaching to promote test success are some of the environmental features that breed stress among student-aged children. CBT and pharmacological interventions are widely considered the best available treatment options for clinically significant anxiety in childhood.

There have been recent efforts in schools throughout the United States to implement multitiered systems of support (MTSS) with an emphasis on schoolwide supports to reduce academic and social stress and anxiety among students, but these efforts are in need of attention and further development. Outside of drastic shifts in the family, school, and community environments, CBT, medication, or some combination of the two, are often implemented to reduce anxiety. In crisis situations, and in cases in which resources are limited, treatment may occur for only a short period, though it is hoped that children with reduced anxiety directly following treatment will continue to experience reduced anxiety in the years that follow.

Ginsburg and team’s work represents a particularly valuable contribution to child anxiety treatment research due to its experimental nature and large sample size (N = 319). Prior to analysis, they hypothesized that 60% of those exposed to some form of treatment would remain in stable remission and that those who’d responded favorably to treatment immediately following the intervention would demonstrate sustained results, regardless of their treatment condition. Participants’ levels of anxiety were assessed on an annual basis for a lengthy diagnostic evaluation and a set of self- and parent-report questionnaires.

Ultimately, descriptive and regression analyses indicated that those who responded initially to treatment had slightly better long-term outcomes than those who hadn’t, but improvements were modest. Younger participants were also more likely to benefit from improved outcomes and remission status as well. Differences in outcomes related to age may have been attributable to the length and severity of the experienced anxiety, and parental involvement in treatment. Notably, youths with higher overall functioning at the onset of treatment, those with parents who’d indicated stronger family bonds, and participants who experienced fewer negative life experiences between treatment and the annual follow-up checks demonstrated a superior response to treatment.

“There may be long-term benefits from early effective treatment with sertraline, cognitive-behavioral therapy, and/or their combination, for anxiety,” the researchers write. “However, for the majority of pediatric patients, anxiety disorders are chronic, and additional treatment and relapse prevention approaches appear warranted.”

The authors suggest that extended treatment and attention paid to relapse prevention could potentially improve outcomes for children exposed to acute treatment for anxiety, but that further research is needed to explore long-term effects of various approaches to therapy over time. Improved supports to children within families, schools, and broader communities to reduce stress could serve to minimize the occurrence and implications of anxiety in childhood.

 

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Ginsburg, G. S., Becker-Haimes, E. M., Keeton, C., Kendall, P. C., Iyengar, S., Sakolsky, D., . . . Piacentini, J. (2018). Results From the Child/Adolescent Anxiety Multimodal Extended Long-Term Study
(CAMELS): Primary Anxiety Outcomes. Journal of the American Academy of Child & Adolescent Psychiatry, 57(7), 471-480. doi:10.1016/j.jaac.2018.03.017 (Link)

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Sadie Cathcart
Sadie Cathcart is a doctoral student and researcher within the Counseling and School Psychology program at the University of Massachusetts, Boston. Sadie belongs to the school psychology track, and her research interests include the psychosocial implications of chronic illness in childhood, relationships between health and educational opportunities, and creative approaches to boosting student and family engagement in learning.

18 COMMENTS

  1. “Increased adverse childhood experiences (ACEs), increased academic expectations imposed, Common Core curriculum initiatives, and the general emphasis in schools on teaching to promote test success are some of the environmental features that breed stress among student-aged children.”

    Why are “CBT and pharmacological interventions … widely considered the best available treatment options for clinically significant anxiety in childhood.” When those treatments have resulted in, “for the majority of pediatric patients, anxiety disorders are chronic?” And why does this failed paradigm imply “additional treatment and relapse prevention approaches appear warranted.”

    The solution would actually include the need for the “mental health” industry to get out of the business of covering up ACEs, by misdiagnosing millions of child abuse victims with the other billable DSM disorders, then creating your “mental illnesses” in these child abuse victims with your psychiatric drugs, resulting in “chronic” outcomes. Today, over 80% of “depressed,” “anxious,” “bipolar,” and “schizophrenia” labeled are actually child abuse victims. Over 90% of those labeled as “borderline” are child abuse victims.

    https://www.madinamerica.com/2016/04/heal-for-life/

    All this misdiagnosis of child abuse victims with the other disorders is the result of child abuse being classified in the DSM as a “V Code,” and the “V Codes” are NOT insurance billable disorders. Thus to get paid, today’s “mental health professionals” MUST MISDIAGNOSE child abuse victims.

    https://www.psychologytoday.com/us/blog/your-child-does-not-have-bipolar-disorder/201402/dsm-5-and-child-neglect-and-abuse-1

    So first of all we need an industry, that can NOT even bill insurance companies for helping child abuse victims, to get out of the business of misdiagnosing child abuse victims, on a massive scale. Because when you misdiagnose ACEs effected or child abuse victims with the other DSM disorders, this changes the topic of conversation away from the child abuse victims real life concerns. And makes the conversation about the “mental health professionals” make believe and scientifically “invalid” DSM disorders. Which, of course, is the opposite of helpful for the child abuse victims or ACEs effected.

    So the current failed, child abuse covering up, DSM paradigm of “mental health” treatments should be gotten rid of altogether, not increased or added to. Common Core and “teaching to promote test success” also should be eliminated. I found teaching from experiences, educational trips, encouraging reading, to greatly enhance my children’s desire to learn. The problems are the systems, not the children, or the children’s brains.

    And I will mention that when a mother keeps her child, who was heartbreakingly abused outside the home, away from the extraordinarily invasive and ineffective “mental health professionals.” And raises that child with love, encouragement, and self esteem building (the opposite of what today’s stigmatizing “mental health professionals” have been doing). Such a legitimately distressed child can go from remedial reading in first grade (after the abuse) to getting 100% on his state standardized tests in eighth grade. Which, of course, results in the confused and insane school social workers wanting to get their grubby little hands on one’s child. Nonetheless, time for private school. And that child can go on to graduate as valedictorian of his high school class, as well as graduate from university Phi Beta Kappa (with highest honors), including winning a psychology department award.

    So basically, childhood anxiety can be cured, if we get rid of the unsuccessful systems. Including a need for the “mental health professionals” to flush their DSM, and do the opposite of what they’ve been doing for the past, too many, decades. Including ending their mass neurotoxic poisoning of children.

    But providing love, encouragement, and self esteem building are curative healing methods. Thus this would not be a profitable business model for today’s multibillion dollar, massive in scale, primarily child abuse covering up, neurotoxic poisoning, we want to manage “life long incurable,” incorrectly assumed to be “genetic” diseases, not cure people, “mental health professionals.”

    Touché, child abuse profiteering “mental health professionals” put me in a catch-22, back at you.

  2. It doesn’t surprise me that children are frightened inside in their houses watching television. “CBT” worked for me for “anxiety” because it showed me how to see “what frightened me” in neutral terms.

    But, it honestly was the effect of the pharmaceuticals that created my overwhelming fear of “everything”.

  3. This study is very unsatisfactory on many levels, but I will focus on the essentials:

    At the end of the CAMS study, just before the CAMELS study, the placebo group began to consume massively psychiatric drugs and therapies!

    Here is the percentage of children who have used psychiatric drugs between the CAMS and CAMELS studies:

    30/44 = 68% (formerly placebo group)
    51/79 = 65% (formerly Sertraline only group)
    52/82 = 63% (formerly Sertraline and CBT group)
    45/83 = 54% (formerly CBT only group)

    And here is the percentage of children who have used psychiatric therapies between these two studies:

    35/44 = 80% (formerly placebo group)
    44/79 = 56% (formerly Sertraline only group)
    43/83 = 52% (formerly CBT only group)
    39/82 = 48% (formerly Sertraline and CBT group)

    (Ginsburg, 2014, Table 3)

    And the formerly placebo group had the worst results at the end of the study!

    Do you realize what that means? This means that the study has exactly opposite results to the conclusions of the authors.

    The CAMELS are a SCAM!

    Bibliography

    Ginsburg GS, (2014). Naturalistic follow-up of youths treated for pediatric anxiety disorders. JAMA Psychiatry. 2014 Mar; 71 (3): 310-8. doi: 10.1001 / jamapsychiatry.2013.4186. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3969570/

    • I would like to point out that the CAMS study lasted from 2002 to 2007, while the CAMELS study started in 2011. In other words, for each participant, 4 to 9 years elapsed between the two studies. 4 to 9 years, when the former placebo group used more drugs and more therapies on the advice of study authors (phase II of the CAMS study).

      And it was these children who had the worst results on the long run. In these circumstances, the conclusion that more drugs and more therapies is needed is pure dishonesty, not to say scientific fraud.

  4. It is astounding how researchers get away with this kind of euphemistic crap! “Study Shows Poor Outcomes for the Treatment for Childhood Anxiety.” In other words, “STANDARD TREATMENT FOR CHILDHOOD ANXIETY DOES NOT WORK!” That’s what the title should be. But they talk all around the issue talking about ‘short-term outcomes’ and “extended treatment and attention paid to relapse prevention could potentially improve outcomes for children exposed to acute treatment for anxiety, but that further research is needed to explore long-term effects of various approaches to therapy over time.” Blah, blah, blah.

    And this is in light of their own statements earlier in the piece that “Increased adverse childhood experiences (ACEs), increased academic expectations imposed, Common Core curriculum initiatives, and the general emphasis in schools on teaching to promote test success are some of the environmental features that breed stress among student-aged children.”

    So why the F*&K don’t we stop traumatizing our kids, stop demanding developmentally inappropriate behavior from our kids in school, drop Common Core, and knock off the high-stakes testing? But no, instead of actually facing up to what they KNOW is causing the increased anxiety, they try to “treat” the children for the anxiety that the adults cause. And they are surprised when their “treatment” doesn’t work?

    —- Steve

  5. Are we surprised that none of this worked? I’m not. The issues these kids have are far deeper than a bit of psychotherapy and an ssri. And you can bet they will have maxed out the dose.

    I think it starts going south when you label them as disordered and needing “treatment”. These youngsters have a problem but of course it’s not a brain disease.

    You have to help get these kids on their feet by having them do things, little by little. The drugs will just numb them up , or possibly worse. Much as I love psychology, I’m not sure kids are amenable to it.

    This study says that current “treatment” is failing kids – the profession simply fails to understand human behaviour. I personally feel it’s the interventions that we call psychosocial that make a difference, just helping them stay plugged into other people and family.

    • And it might help if the adults started by recognizing that these kids are reacting to the way the ADULTS are treating them. Most of the kids’ anxiety could be relieved by removing the kind of pressures, stresses and traumatic experiences they are being expected to deal with.

      • Maybe it’s down to adults, maybe it’s peer group, but there’s no doubt about it, a mental crash is serious and life-threatening. But it frankly incenses me the way the so called professionals label them as disordered, “seriously ill” and suffering from the ludicrous chemical imbalance that only the pros know how to correct. When you hit the skids the last thing you need is BS and undermining. All they ever offered was sedation, false promises of recovery after they’ve mentally crippled you, and the threat of incarceration because you’re still not better. No honesty, no choices, no clue.

        There IS no serious illness, no imbalance, no therapeutic medication, no wisdom, no experience of getting people better. Exercise? Sport? Oooh no, it just makes people think like they are failing apparently. The BS only stops when you manage to push them away.

        Then how about “we believe in you”, “you’re not broken”, “it’s ok to be crashed out”, “we think you are special”, “take your time”, “let’s try and do a few little things”…etc

        …sorry, it’s been a slight rant…

      • Steve-
        It can also be an energy thing, the kid holding the energy of family secrets, even if the kid does not know the content of the secret. A kid sensitive to energy might not know that mom has a drinking problem or dad is having an affair, but they feel the burden, the heaviness of the secret going on and internalize the energy of it. And to feel the energy of something you can’t explain, but to feel the extent you are subjected to it, is truly crazy-making.

        • This is something I believe and used to hear a lot, when Family Systems theory was taken more seriously. While I am not fond of psychological schools of thought in general, Family Systems theory has some really excellent points, including the idea that the family offloads their issues onto the kids (who have the least power) by assigning them “jobs” or “roles” that they don’t understand or even know they are playing. A lot of our adult issues come from exactly this, and that’s why it’s so important to talk to kids (or adults) about what’s happening instead of blaming the kid for acting in ways the adults find inconvenient or confusing.

          • You mean like the dysfunctional family with one kid (the SMI labeled one) who serves as the “scapegoat” while others play the “golden child” and “winged monkeys” and other roles assigned by the cold, selfish “narcissist” at the center creating the whole drama?

          • Precisely. I was the scapegoat in my family for the first 8 years of my life, at which point I got seriously ill (ruptured appendix) and I had a younger brother born. The job passed on to my next younger brother, who used to be in “the baby” role until my youngest brother was born that year. By this strange twist of fate, I got to see first hand that being the scapegoat was not who I was, but a job I’d been assigned, and saw it reassigned to my little brother. This gave me a sudden and deep insight into my own family, and probably led me into social work/counseling as a profession. But only after I got my own very good counseling to get my own head straight.

          • Rachel, you put it so perfectly and succinctly. I think that’s the biggest illusion in all this, and what causes such crazy-making problems, all this behind-the-scenes manipulation—which, btw, people who are extremely sensitive to energy can feel yet it can be hard to put one’s finger on. If we follow the thread of that feeling–the energy of it–we do get to the truth.

            But in a dysfunctional and programmed system, people turn a blind eye because that truth will challenge the system, and the beliefs/norms on which it operates, way too much by making people feel and acknowledge things they’ve for so long tried to avoid. That’s an opportunity for the system to heal, change, and grow, but it most often resist this, for so many reasons—e.g., resistance to change, not wanting to face hard truths, etc.

            Personally, I find it so interesting to both study and experience. I went through this with my family. I wasn’t exactly IP’d as a kid, but I did stand out because I was open with my feelings and was truly a present-time kind of person in a very academically oriented family. I was a good student, but I was more into the arts and more of a “free spirit,” which had both its positives and negatives, but overall, I was in the flow as a kid. It was later I had issues and sought help, which began my journey. But we all got our turns being IP’d in a very narcissistically oriented household. My folks were quite emotionally needy, and we were “trained” to fill in those gaps, which of course is a big role for a kid, very oppressive and not freeing.

            And it was much, much later, while I was going through the system and feeling like the IP of the world, that I began to speak my truth to my family, how that system had affected me, and THAT is when something switched in my family and as an adult, I was viewed as “other” and “lesser than”–starting in my 40s, which was a huge blow to me and it led to ego death and having to do consciousness shifting work, if only for my survival.

            That has been my work for years now, because it started to create shifts in this dynamic, to my favor. I began to give all that energy back that wasn’t mine to begin with, and indeed, as I followed that thread through this kind of yucky feeling, it led to a lot of truth that did amount to exactly what you say here–

            “while others play the “golden child” and “winged monkeys” and other roles assigned by the cold, selfish “narcissist” at the center creating the whole drama”

            There has been one person in particular in my family who I discovered was doing this, all behind-the-scenes, and it became extremely obvious from the conversations I was having with other family members and all these contradictions started coming to light.

            The other family members had become unwitting enablers because they believed what they were hearing due to the fact that it fit the program. The one playing the role of “narcissistic abuser” knows the dysfunctional program well and how to keep the power structure in place. It is so fascinating to actually watch this in progress, from the inside out, based on shifting internally one’s self-identity and speaking a new truth, or at least, speaking one’s truth with conviction and integrity. It is a very powerful action and it creates change.

            It was extremely confusing as I processed these conversations, both internally and also with a couple of people in my life with whom I discuss these things, and I realized exactly how the gaslighting was working, not to mention a bit of Munchausen by Proxy and all sorts of seeds-planting based on lies. All in order to create (manipulate into being) a really powerful illusion which would amount to casting shadow over me and in essence, stealing my light. Exactly the same as I experienced in the “mental health” system = stigma. That’s the tool used to create IPs. It is energy-sucking, by design.

            It was amazing to finally see and feel the light on all this. Cracked the code for me. How you say it is spot on, that is exactly how it went. And after years of speaking my truth about it, allowing myself to go into the confusion of it, and then getting my clarity, I am seeing the system changing yet again, and this time, I have way more power because I changed my role in the family.

            And that narcissistic gaslighting abuser? That person is fading from the system it would seem. This is all a family healing work-in-progress and it’s new ground for me so every moment is a surprise. But so far it seems to be working because I made it a point to challenge what they had started to project on me, and I did it out loud, first to the narcissist who started this–and that was a disaster as we all know can be expected, it simply confirms what we know and they pull from their bag of tricks again, and it can lead to retaliation. So then, I started speaking my truth to the one person in the system that I felt could possibly hear me, and that started to shift the energy, slowly but surely.

            Being sensitive to energy, as many of us are who go through these journeys in the assigned role of “MI,” or “the diagnosed one,” is a curse and a gift. At first, it feels impossible to manage life being so senstive with all the harsh energies of the world right now. It’s why we tend to become the peacemakers, we want peace in the world so badly, so that we can get on with things and not be in constant conflict, which is what can add so much static to the collective energy. Conflict can lead to clarity, but sometimes it just seems to beget more conflict, as a norm in the paradigm, far and away from the peace we seek.

            As a “sensitive,” a person can learn to work with this quality and it becomes radar-like, which is a powerful tool in life, but we have to know how to take care of ourselves and how to keep our own energy nourished so that it does not become depleted. I think anyone could benefit from learning this, but being a sensitive type actually requires this for not only survival, but also in order to create a good quality of life, I believe.

            I think it’s also important to keep perspective and remember that these assigned roles are illusions which we can shift, but we do have to work the system, somehow, and what I always say is simply to follow your truth, whatever that means to you. In other words, don’t doubt your information. If it *feels* funky, it more than likely is, regardless of what anyone around you says if you are the only one noticing it. You’re not crazy, you’re a visionary, and those around you are more than likely in denial, if they are trying to make you feel crazy.

            Every voice matters, but the IP is the one carrying all the information. Once they can process it, it is gold. Whether or not others in the system listen is 50/50, but believing in our own truth is empowering, and in my experience, leads to good changes, one way or another.

            Thanks, Rachel, your clarity is extremely inspiring and encouraging to me.