Literature Review
This paper presents a critical analysis of five research articles related to the proposed PICOT question: In a group of patients between the ages of 13-18 with complaints of anxiety (P), does the implementation of a family-based therapy program or behavioral therapy program (I), compared to pharmacological interventions (C), resulting in a reported decrease in anxiety symptoms (O) within 12 weeks (T)? The researcher selected this question from many clinically approved topics. In this case, the topic selected includes the impact of implementing a family-based therapy on anxiety disorders in adolescents aged between 13 to 18 years in primary care.
To locate the relevant sources evaluating family-based therapy, various databases, including Google Scholar, Semantic Scholar, Research Gate, and the American Journal of Mental Health, were consulted. Information was restricted to the current information published in English from January 2017 to April 2021. The keywords used in the systematic review included anxiety disorders, teenage behavioral therapy, and family-based care for adolescents with mental health disorders.
Systematic Review of Five Research Articles
The first journal acritical analysis is both a meta-analysis and a systematic review source entitled “Family‑Based Psychological Treatment for Obsessive-Compulsive Disorder in Children and Adolescents: A Meta‑analysis and Systematic Review.” It was written by McGrath and Abbott in 2019 and published in the journal Clinical Child and Family Psychology Review. The article falls under the level I of the EPB pyramid level of evidence. The study aimed to evaluate the effectiveness of family-oriented interventions for adolescents and children with obsessive-compulsive disorders (McGrath & Abbott, 2019). Two types of family interventions were included: parental inclusion with direct address of family factors and parental involvement with indirect family aspects.
In the systematic review, the authors recruited 1327 participants in uncontrolled and randomized control trials (McGrath & Abbott, 2019). Semi-structured interviews were used to assess participants’ clinical characteristics, and outcome measures included the Children’s Yale-Brown Obsessive-Compulsive Scale (McGrath & Abbott, 2019). For the meta-analysis, the authors included 1227 participants, and they performed a randomized selection of participants and a risk analysis to evaluate the articles they reviewed. They found that family-related issues should be minimized to optimize treatment responses. Influential family factors include conflict, family cohesion, and the blames that families place on adolescents. The authors asserted that there are many family factors affecting treatment outcomes, hence the need to address a wide range of them. Although most studies considered involved few family factors, the information will be helpful to my study as essential factors have been explained.
The second article reviewed is titled “Very Early Family-Based Intervention for Anxiety: Two Case Studies With Toddlers.” It was written in 2019 by five authors, including Hirshfeld-Berker, Henin, Rapoport, Wilens, and Cater, and registered in general psychiatry journals. The articles fall under level IV of EBP evidence, and their primary objective is to examine whether early interventions for family-based cognitive-behavioral therapy can be extended to toddlers under three years to treat anxiety. The authors used two case studies involving anxious children of ages 26 and 35 months who were treated with child cognitive behavioral therapy and the parents.
The article recruited parents of children between ages 21 and 35 months through advertisement to the community to engage in a pilot intervention study. Children included in the study were rated by parents as over a standard deviation on the early childhood behavior questionnaire fear or shyness scale 20. The authors ensured that children involved were confirmed to lack the presence of global developmental delays, primary psychiatric disorder, or autism spectrum disorder other than anxiety. Case study one involved a 35 months old girl with married parents and two siblings (Hirshfeld-Becker et al., 2019). The girl had congenital medical issues that necessitated multiple surgeries, and regular follow-ups created anxiety disorders associated with severity and mild social and specific phobia.
The second case involved a 26 months boy and the only child of his parents, who is married. The boy suffers from a separation anxiety disorder, mainly due to attending daycare since infancy. The two pilot cases found parent-child cognitive behavioral therapy for toddlers suffering from anxiety disorder feasible and acceptable, as both children demonstrated a decreased number of the disorder and moderate to much improvement. Their parent-rate ability to deal with feared situations also increased, and the toddlers gained competence in the mastery of motivation and prosocial peer interactions.
The article’s strengths come from intensive analysis of diagnoses, coping ability, symptoms, and family function in both participants and their parents through the involvement of clinicians. Its weakness is a small sample; of two participants, hence the need for further evidence (Hirshfeld-Becker et al., 2019). The study is relevant as it will enable the researcher to compare existing literature within their study’s context and justify the need for further analyses.
Another article considered is in level 1 evidence in the pyramid titled “A Randomized Controlled Trial of a Bidirectional Cultural Adaptation of Cognitive Behavior Therapy for Children and Adolescents with Anxiety Disorders.” It was written by five authors from different institutions and registered in journals of behavioral research therapy in 2019 (Ishikawaa et al., 2019). According to the authors, it is the first randomized control trial on CBT for children and adolescents fighting anxiety disorders using bidirectional cultural adaptation.
The study used the Japanese Anxiety Children/Adolescence Cognitive Behavior Therapy (JACA-CBT) program, which was created on the basis of evidence-based CBT for youths with anxiety. The study was optimized through feedback obtained from clinicians in all indigenous cultural groups involved. Participants included fifty-one children and adolescents with anxiety disorder ages 8 to 15 who were randomly allocated to either a waist-line control condition (WLC: 70.00 days, SD = 11.01) or a cognitive-behavioral treatment (CBT: 122.08 days, SD = 48.15) (Ishikawaa et al., 2019). Participants were assessed at different times, including post and pre-treatment three and six months after treatment. The assessment was done through diagnostic interviews, self-report measures of anxiety, parent-report anxiety, and cognitive errors using questionnaires.
The article established that, during treatment, half of the participants are free from their principle diagnoses while in wait-list condition only 12 percent (χ2 (1, N = 51) = 8.55, η2 = 0.17, p <.01). They also demonstrated noteworthy improvements in child-self reported depression and clinical severity F (1, 49) = 12.38, p <.001, F (1, 47.60) = 5.95, p <.05 (Ishikawaa et al. 2019). At post-treatment, the findings on the four main factors were: clinical severity was 1.00 (95% CI = 0.42–1.58), while moderate, 0.43 in self-report anxiety on a scale of 0.19-1.04. The article used two scales for depression which are 0.22-1.00 and 0.14-1,09, and the outcomes were 0.39 and 0.48 consecutively (Ishikawaa et al., 2019). Cognitive errors were measured on a scale of 0.24-0.99, and the results were 0.38. The 3 and 6 months follow-ups showed meaningful improvement in participants’ diagnostic status. The authors concluded that CBT is transportable in the population and that bidirectional, culturally adaptive behavior therapy is effective in an underrepresented population.
The next article reviewed is level 1 evidence with the title “Complete Recovery from Anxiety Disorders Following Cognitive Behavior Therapy in Children and Adolescents: A Meta-Analysis.” It was prepared by seven authors with different credentials and was registered in Clinical Psychology Review in 2017. The article aimed to conduct a meta-analysis on the efficacy of cognitive-behavioral therapy in terms of the non-existence of anxiety disorder (Warwick et al., 2017). The analysis is important as previous similar analysis asserts that more than 60 percent of children recover from treatments but with a lack of specific results on whether they are free of anxiety disorders.
Studies to be included in the analysis had to meet the Cochrane review and other criteria specified by the authors to meet the requirements of the study. Studies were excluded if their participants had simple phobias, selective mutism, PTSD, or OCD. The authors identified studies for inclusion through Cochrane review and updated searches imitating the Cochrane search strategy. The analysis used data from both published papers and unpublished data from seven studies, including the press manuscript.
The authors extracted data concerning participants’ gender, age, number, method of diagnostic assessment, mode of delivery, parental involvement, duration of treatment, and others necessary to the study. The article comprises 56 published randomized control trials, 19 of which provided data on anxiety disorder recoveries (n=635 CBT, n=450 control participants). The authors used a random effect model for every meta-analysis to incorporate the varied populations involved in the review. The authors realized heterogeneity across the selected studies, and the recovery rates among children lacking ASC (autistic spectrum condition) varied from 47.6 to 66.4 percent, while those with the condition varied from 12.2 to 36.7 percent (Warwick et al., 2017). However, the authors noticed a lack of consistency in diagnostic results, which calls for consensus on reporting childhood anxiety disorder in future RCTs for the data to be helpful. The samples used in most studies were also very small; therefore, inappropriate to generalize the outcomes. The review will be relevant to my projects because the studies included providing sufficient descriptions of treatments such as integrity and assessment and outcome measures through intensive data analysis ad appropriate conclusions.
The last article considered appeared in the Journal of the American Academy of Child & Adolescent Psychiatry in 2019. The article is a level 1 evidence, titled “Systematic Review: Anxiety in Children and Adolescents with Chronic Medical Conditions.” The study’s objective is to review existing literature on anxiety and the seven CMCs on young people systematically (Cobham et al., 2019). According to the Preferred reporting items for systematic reviews and meta-analysis (PRISMA) statement, the authors reviewed the literature. Studies from 1990 to 2018 from PubMed, Embase, and PsycNET were included in the review. Only those that recorded the prevalence of anxiety and its association with disease-related results in adolescence and children with focal CMCs were considered.
The review involved fifty-three studies and established that the pervasiveness of anxiety disorder is higher in youths than in the general population. However, there is a limited relationship between anxiety and unfavorable disease-related results. Although anxiety could be linked to disease-related outcomes for young people, it is impossible to systematically establish a decisive conclusion (Cobham et al., 2019). Screening and treatment for anxiety among youths should be a priority to health providers considering the burden on the disorder regardless of its impact on other disease outcomes. The article provides intensive information on disease-related outcomes, which will be helpful in my study as anxiety is directly connected to them and cannot be studied alone.
Summary of What is Known
The current strategy of treating the condition is faulty hence the need for family-based cognitive-behavioral therapy. Anxiety disorder is a popular psychiatric disorder in children and youths, and it is associated with other diseases at different levels. This information is evident in various literature reviewed in this study (Cobham et al., 2019; Hirshfeld-Becker et al., 2019; Ishikawaa et al., 2019; McGrath and Abbott, 2019; Warwick et al., 2017). Both the parents and the children actively and directly intervene (McGrath & Abbott, 2019; Perna et al., 2020; Bandelow et al., 2017). The existing literature on the issue is inconsistent, and therefore clinicians and health care providers need further research on CBT (Warwick et al., 2017; Cobham et al., 2019; Cianetti et al., 2020; Butler et al., 2018). However, with increased tailoring of aspects of CBT, it is possible to utilize the practice in various populations (Ishikawaa et al., 2019; Brew et al., 2018; Zilcha-Mano et al., 2020; Dekel et al., 2020). The disorder should be taken with seriousness given to other diseases as its burden and potential adverse health outcomes linked to mental illness among the youths continues to increase.
References
Bandelow, B., Michaelis, S., & Wedekind, D. (2017). Treatment of anxiety disorders. Dialogues in Clinical Neuroscience, 19, 93 – 107. Web.
Brew, B. K., Lundholm, C., Gong, T., Larsson, H., & Almqvist, C. (2018). The familial aggregation of atopic diseases and depression or anxiety in children. Clinical & Experimental Allergy, 48(6), 703-711. Web.
Butler, A., Van Lieshout, R. J., Lipman, E. L., MacMillan, H. L., Gonzalez, A., Gorter, J. W.,… & Ferro, M. A. (2018). Mental disorder in children with physical conditions: A pilot study. BMJ Open, 8(1), e019011. Web.
Cianetti, S., Lombardo, G., Lupatelli, E., Pagano, S., Abraha, I., Montedori, A…. & Salvato, R. (2017). Dental fear/anxiety among children and adolescents. A systematic review. European Journal of Paediatric Dentistry, 18 (2), 121-130. Web.
Cobham VE, Hickling A, Kimball H, Thomas HJ, Scott JG, Middeldorp CM. (2019). Systematic review: Anxiety in children and adolescents with chronic medical conditions. Journal of the American Academy of Child & Adolescent Psychiatry (2019), Web.
Dekel, I., Dorman-Ilan, S., Lang, C., Bar-David, E., Zilka, H., Shilton, T., Lebowitz, E.R., & Gothelf, D. (2020). The feasibility of a parent group treatment for youth with anxiety disorders and obsessive compulsive disorder. Child Psychiatry and Human Development. Web.
Hirshfeld-Becker D. R, Henin A, Rapoport S. J, Wilens T. E and Carter A. S. (2019). Very early family-based intervention for anxiety: Two case studies with toddlers. General Psychiatry 32. Web.
Ishikawaa S., Kikutaa K., Sakaib M., Mitamurac T., Motomurad N. and Hudson J. L. (2019). A randomized controlled trial of a bidirectional cultural adaptation of cognitive behavior therapy for children and adolescents with anxiety disorders. Behavior Research and Therapy, 120. Web.
McGrath C. A., & Abbott M. J. (2019). Family‑based psychological treatment for obsessive compulsive disorder in children and adolescents: A meta‑analysis and systematic review. Clinical Child and Family Psychology Review. Web.
Perna, G., Alciati, A., Sangiorgio, E., Caldirola, D., & Nemeroff, C. (2020). Personalized clinical approaches to anxiety disorders. Advances in Experimental Medicine and Biology, 1191, 489-521. Web.
Warwick H., Reardon T., Cooper P., Murayama K., Reynolds S. Wilson C. and Creswell C. (2017). Complete recovery from anxiety disorders following Cognitive Behavior Therapy in children and adolescents: A meta-analysis. Clinical Psychology Review 52 p 77–91. Web.
Zilcha-Mano, S., Shimshoni, Y., Silverman, W., & Lebowitz, E.R. (2020). Parent-child agreement on family accommodation differentially predicts outcomes of child-based and parent-based child anxiety treatment. Journal of clinical child and adolescent psychology: the official journal for the Society of Clinical Child and Adolescent Psychology, American Psychological Association, Division 53, 1-13. Web.