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Child and adolescent Anxiety: Most effective treatments combine CBT and pharmacotherapy

Authors of a new study in the New England Journal of Medicine reported that anxiety disorders in children and adolescents negatively affect school performance, family relations, and social functioning. Despite a high prevalence (10-20%), they are largely “underrecognized and undertreated.” The anxiety disorders evaluated in this study included separation and generalized anxiety and social phobia. Cognitive behavioral therapy (CBT) and selective serotonin-reuptake inhibitors (SSRIs) have already been demonstrated to be effective in this group but a randomized controlled study of the two in combination has been lacking.

To address this, children ranging in age from 7 to 17 received CBT, an SSRI (sertraline/Zoloft) or placebo, or a combination of the CBT and sertraline. The CBT involved fourteen 60-minute sessions and included anxiety-management skills and behavioral exposure to anxiety-provoking situations.

The authors found that improvement was greatest for the combination therapy (80.7%), followed by cognitive behavioral therapy alone (59.7%), then sertraline alone (54.9%), and all therapies were superior to placebo (23.7%). An interesting additional finding was that “there was less insomnia, fatigue, sedation, and restlessness associated with cognitive behavioral therapy than with sertraline.”

The authors concluded that “all three of the treatment options may be recommended, taking into consideration the family’s treatment preferences, treatment availability, cost, and time burden.”

Study authors: J. T. Walkup, A.M. Albano, J. Piacentini, B. Birmaher, et al.