TABLE 2.
RCTs contributing to the evidence-based status of brief, non-pharmacological interventions for anxiety and phobias in youth.
| Study | Sample characteristics | Significant program effects | Criteria |
|---|---|---|---|
| Anxiety (n = 66) | |||
| Hains (1992) | N = 25. Ages 15 to 16 years. Mean age not reported. 0% girls. Randomized to individual plus group cognitive-behavioral stress management intervention (CBSMI), individual plus group anxiety management training (AMS), or waitlist control. | Intervention conditions did not differ from one another. At posttest and 3-week FU, CBSMI and AMS led to lower STAIC state anxiety, STAIC trait anxiety, STAXI trait anger, STAXI state anger, and RCADS depression than control. | M.1 to M.4 |
| Kiselica et al. (1994) | N = 48. 9th grade students. Mean age not reported. 46% girls. Top 12 highest scores in classroom on STAIC-T anxiety. Randomized to stress inoculation training or usual care. | At posttest and 1-month FU, stress inoculation training led to lower STAIC trait anxiety than usual care. No other between-group differences emerged on SOSI stress or GPA. Stress inoculation training led to lower SOSI stress at posttest and FU. | M.1 to M.5 |
| Barrett et al. (2000) | N = 20. Ages 14 to 19 years (M = 16.30). Former Yugoslavian Refugee in Australia. Randomized to group cognitive behavior therapy (GCBT) or waitlist control. | At posttest, GCBT led to reduced YSR anxiety/depression than control. GCBT led to lower YSR internalizing, SCAS anxiety, and ASP cognitive styles but between-group differences were not evident. | M.1 to M.4 |
| Barrett et al. (2001) | N = 204. Ages 7 to 19 years (M = 12.50). Non-English-speaking Background in Australia. Randomized to GCBT or waitlist control. | At posttest, GCBT led to more improvements in BHS future outlook/hopelessness, SEI school self-esteem, RSES self-esteem, and reductions in RCMAS anxiety than control. | M.1 to M.5 |
| Ginsburg and Drake (2002) | N = 12. Ages 14 to 17 years (M = 15.60). 83% girls. DSM GAD, Specific Phobia, SoP, SAD. Randomized to GCBT or attention control. | At posttest, GCBT led to lower ADIS-C/P CSR severity and SCARED-C anxiety than control. GCBT led to lower SAS-A social anxiety, but between-group differences were not evident. | M.1 to M.4 |
| Heyne et al. (2002) | N = 61. Ages 7 to 14 years (M = 11.50). 46% girls. Met school refusal criteria as defined by Berg et al. (1969) and DSM GAD, Specific Phobia, SAD, SoP. Randomized to ICBT, ICBT plus parent teacher training (ICBT+PTT), or parent/teacher training (PTT) only. | At posttest, ICBT+PTT and PTT led to higher school attendance than ICBT. ICBT +PTT also led to lower CBCL internalizing symptoms than ICBT at posttest. In addition, PTT led to significantly less FSSC-R fear of the unknown, RCMAS worry and oversensitivity, and RCMAS physiological anxiety than ICBT. Additional between-group differences were not evident for any outcome at posttest or 4.5-month FU. All conditions led to lower FSSC-R fears, RCMAS anxiety, CDI depression, and higher SEQSS self-efficacy at posttest. At FU, ICBT+PTT led to lower FSSC-R fear and RCMAS worry/oversensitivity, ICBT led to lower FSSC-R fear, RCMAS physiological complaints and higher SEQSS self-efficacy. At FU, 69% (across all conditions) no longer met ADIS-C/P CSR diagnostic criteria for any anxiety disorder. | M.1 to M.5 |
| Muris et al. (2002) | N = 30. Ages 9 to 12 years (M = 10.00). 43% girls. RCADS ≥ 9 (boys) or 11 (girls) anxiety symptoms and DSM GAD, Specific Phobia, SAD, SoP. Randomized to ICBT, emotional disclosure treatment (ED), or no treatment control. | At posttest, ICBT led to lower RCADS anxiety, RCADS depression, STAIC trait anxiety than control and ED. At posttest, RCADS anxiety recovery rates were 80% in ICBT vs 40% in ED and 30% in control. | M.1 to M.4 |
| Gallagher et al. (2004) | N = 23. Ages 8 to 11 years. Mean age not reported. 52% girls. DSM SoP. Randomized to GCBT or waitlist control. | At posttest, GCBT led to lower CBCL anxiety/depression than control. At 3-week FU, GCBT led to lower SPAI-C social anxiety, RCMAS anxiety, CDI depression, and CBCL anxiety/depression than control. No other between-group differences emerged on SASC-R social anxiety, CBCL social competence, CBCL activities, or CBCL school problems. Both GCBT and control led to lower SASC-R social anxiety at posttest and FU. | M.1 to M.4 |
| Bernstein et al. (2005) | N = 61. Ages 7 to 11 years (M = 9.00). 66% girls. 53% girls. DSM GAD, Specific Phobia, SAD, SoP. Randomized to GCBT, GCBT plus parent training, or no-treatment control. | At posttest, 3-, and 6-month FU, GCBT and GCBT plus parent training led to lower MASC-P anxiety, SCARED-P anxiety, ADIS-C/P CSR severity, and CGI functioning than control. Stronger pre to posttest changes were found for GCBT plus parent training than GCBT for CGI functioning. At 12-month FU, GCBT and GCBT plus parent training led to lower CSR severity ratings than control, with improvements in CGI functioning being maintained at 3-year FU (Lee et al., 2017). | M.1 to M.5 |
| Mifsud and Rapee (2005) | N = 425. Ages 8 to 11 years (M = 9.5). 59% girls. RCMAS ≥ 18 RCMAS anxiety symptoms. Randomized to GCBT or waitlist control. | At posttest and 4-month FU, GCBT led to lower RCMAS anxiety, SCAS anxiety, SCAS-P anxiety, CATS automatic thoughts, and TRF emotional and behavioral problems than control. | M.1 to M.5 |
| Rapee et al. (2005) | N = 146. Ages 3 to 5 years (M = 3.9). 55% girls. STSC-approach subscale >30. Randomized to parent-education intervention or assessment only control. | Between-group differences were not evident for any outcome at posttest. Both parent-education intervention and control led to improvements in STSC-C/P temperament, TABC-R-P temperament, and behavioral inhibition measured via approach tasks. At 12-month FU, parent-education intervention had fewer ADIS-C/P CSR anxiety disorder diagnoses than control. At 11-year FU, girls in the parent-education intervention had lower SCAS-P anxiety, CALIS-C life interference, and fewer ADIS-C/P anxiety disorder diagnoses than control and boys in the intervention condition (Rapee, 2013). | M.1 to M.5 |
| Dadds and Roth (2008) | N = 734. Ages 3 to 7 years. Mean age not reported. 47% girls. Randomized to parent-focused ICBT or no intervention control. | At posttest, parent-focused CBT led to lower teacher reported SCBE child anxious-withdrawn and angry-aggressive behaviors and higher SCBE social competence than control. Between-group differences were not evident at 7-month FU. | M.1 to M.5 |
| Aune and Stiles (2009) | N = 1,439. Ages 12 to 14 years. Mean age not reported. 52% girls. Randomized to GCBT plus psychoeducation for parents, teachers, and community health workers or no intervention control. | At posttest, GCBT led to lower SPAI-C social anxiety and SCARED anxiety than control. | M.1 to M.5 |
| N = 190. Ages 12 to 14 years. Mean age not reported. 52% girls. Post-hoc subsample. SPAI-C ≥ 18 social anxiety symptoms. Randomized to GCBT plus psychoeducation for parents, teachers, and community health workers or no intervention control. | At posttest, GCBT led to lower SPAI-C social anxiety and SCARED anxiety than control. | M.1 to M.5 | |
| Calear et al. (2009) | N = 1,477. Ages 12 to 17 years. Mean age not reported. 56% girls. Randomized to internet-delivered CBT (iCBT) or waitlist control. | At posttest and 6-month FU, iCBT led to lower RCMAS anxiety than control. | M.1 to M.5 |
| Ginsburg (2009) | N = 40. Ages 7 to 12 years (M = 8.94). 45% girls. Parents met DSM criteria for GAD, Specific Phobia, SAD, SoP. Randomized to parent-focused ICBT or waitlist control. | At posttest, 6-month, and 12-month FU, family-focused ICBT led to lower ADIS-CSR severity and SCARED-P anxiety than control. At 12-month FU, family-focused ICBT led to fewer ADIS anxiety disorder diagnoses than control (0% vs. 30%). | M.1 to M.5 |
| Hunt et al. (2009) | N = 260. 9th grade students. Mean age and sex not reported. 43% girls. RCMAS >1SD above mean of a normative sample. Randomized to GCBT or assessment only control. | Between-group differences were not evident for any outcome at posttest, 2-year FU, and 4-year FU. Both GCBT and control led to lower RCMAS anxiety at 4-year FU. | M.1 to M.5 |
| Balle & Tortella-Feliu (2009) | N = 92. Ages 11 to 17 years. Mean age and sex not reported. CASI >80th percentile for anxiety sensitivity. Randomized to GCBT, waitlist, or no intervention control. | Between-group differences were not evident at posttest. Both GCBT and control conditions led to lower CASI anxiety sensitivity and SCAS-P anxiety symptoms. At 6-month FU, GCBT led to lower CASI anxiety sensitivity than controls. | M.1 to M.5 |
| Khanna and Kendall (2010) | N = 49. Ages 7 to 13 years (M = 10.10). 33% girls. DSM GAD, Specific Phobia, SAD, SoP. Randomized to computer-assisted CBT (CCAL), ICBT, or computer-assisted attention control. | Intervention conditions did not differ from one another. At posttest and 3-month FU, CCAL and ICBT led to lower ADIS-C/P CSR severity than control. No other between-group differences emerged on CGAS functioning, MASC-C anxiety, or CDI-C depression. CCAL and ICBT demonstrated reductions in MASC-C anxiety and CDI-C depression at posttest. | M.1 to M.5 |
| Miller et al. (2010) | N = 118. Ages 7 to 12 years (M = 9.75). 50% girls. Randomized to GCBT or waitlist control. | Between-group differences were not evident for any outcome at posttest. Both GCBT and control led to lower MASC anxiety and BASC-IC internalizing symptoms. | M.1 to M.5 |
| N = 33. Ages 7 to 12 years (M = 9.75). 50% girls. Post-hoc subsample. MASC anxiety >56. Randomized to GCBT or waitlist control. | At posttest, GCBT led to lower MASC anxiety than control. | M.1 to M.5 | |
| Pahl and Barrett (2010) | N = 263. Ages 4 to 6 years (M = 4.56). 48% girls. Randomized to GCBT or waitlist control. | At posttest, GCBT led to lower BIQ-T behavioral inhibition and higher BERS-T social-emotional competence than control. No other between-group differences emerged on PAS anxiety, BIQ-P behavioral inhibition, or BERS-P social-emotional competence. GCBT led to lower PAS anxiety, BIQ-P behavioral inhibition, and higher BERS-P social-emotional competence at posttest and 12-month FU. | M.1 to M.5 |
| Bar-Haim et al. (2011) | N = 34. Age 10 years (M = 10.10). 71% girls. SCARED >50th percentile for anxiety symptoms. Randomized to attention bias modification training (ABMt) or attention control training (ACT). | At posttest, ABMt led to higher rates of disengagement from threat and were less vulnerable to the stress induced by the stressor task than ACT. No additional between-group differences were evident, with both ABMt and ACT having led to lower STAIC trait anxiety at posttest. | M.1 to M.5 |
| Miller, Laye-Gindhu, Liu, et al. (2011) | N = 191. Ages 9 to 12 years (M = 10.1). 48% girls. MASC anxiety T-score of ≥ 56. Randomized to GCBT or attention control. | Between-group differences were not evident for any outcome at posttest, 5-month, or 17-month FU. | M.1 to M.5 |
| N = 42. Ages 9 to 12 years (M = 10.1). Post-hoc subsample. MASC anxiety T-score of >65. Randomized to GCBT or attention control. | Between-group differences were not evident for any outcome at posttest, 5-month, or 17-month FU. | M.1 to M.5 | |
| Miller, Laye-Gindhu, Liu, et al. (2011) | N = 253. Ages 9 to 12 years (M = 9.80). 54% girls. Randomized to GCBT or attention control. | Between-group differences were not evident for any outcome at posttest or 17-month FU. | M.1 to M.5 |
| N = 64. Ages 9 to 12 years (M = 9.80). Post-hoc subsample. MASC anxiety T-score of >65. Randomized to GCBT or attention control. | Between-group differences were not evident for any outcome at posttest or 17-month FU. | M.1 to M.5 | |
| Miller, Laye-Gindhu, Bennett, et al. (2011) | N = 553. Ages 9 to 12 years (M = 9.77). 50% girls. Randomized to GCBT or waitlist control. | Between-group differences were not evident. At posttest and 3-month FU, GCBT led to lower MASC anxiety. | M.1 to M.5 |
| Stallard et al. (2011) | N = 20. Ages 11 to 16 years. Mean age and sex not reported. Seeking services at Tier 3 Child and Adolescent Mental Health Services with DSM GAD, Specific Phobia, SAD, SoP or mild-moderate depression. Randomized to computer-assisted CBT or waitlist control. | No between-group analyses were conducted. Both computer-assisted CBT and control led to improved RSEI self-esteem and SQC cognitive schemas. Computer-assisted CBT also led to lower SCAS social phobia SDQ-P emotional difficulties, SDQ-P hyperactivity, AWS depression, and improved SDQ-P total strengths and difficulties. Control also led to lower SCAS physical injury fears. | M.1 to M.4 |
| Tillfors et al. (2011) | N = 19. Ages 15 to 21 years (M = 16.50). 89% girls. DSM SoP. Randomized to iCBT or waitlist control. | At posttest and 1-year FU, iCBT led to lower SPSQ-C social anxiety, LSAS-RS social anxiety, BAI anxiety, and MADRS-S depression than control. | M.1 to M.4 |
| Attwood et al. (2012) | N = 13. Ages 10 to 12 years (M = 10.6). 0% girls. Randomized to computer-assisted CBT or computer gaming control. | At posttest, computer-assisted CBT led to lower SCAS anxiety, SCAS social anxiety, and SCAS generalized anxiety than control. | M.1 to M.4 |
| Eldar et al. (2012) | N = 40. Ages 8 to 14 years (M = 9.84). 45% girls. DSM GAD, Specific Phobia, SAD, SoP. Randomized to ABMt away from threat, placebo attention control training using ABMt stimuli, or placebo attention training using neutral stimuli. | At posttest, ABMt led to greater reductions in dot-probe task attentional bias and ADIS-IV-C/P anxiety symptom counts compared to controls. At posttest, 33% of children in the ABMt condition no longer met ADIS-C/P CSR diagnostic criteria for any anxiety disorder, compared to 13.3% in the placebo condition, and 0% in the neutral placebo condition. No other between-group differences emerged on SCARED-anxiety or CDI-C depression, with all three conditions having led to lower SCARED-C anxiety and CDI-C depression. | M.1 to M.5 |
| Ginsburg et al. (2012) | N = 32. Ages 8 to 12 years (M = 10.28). 63% girls. DSM GAD, Specific Phobia, SAD, SoP. Randomized to modular ICBT or usual care. | Between-group differences were not evident for any outcome at posttest and 1-month FU. Both modular ICBT and usual care led to lower ADIS-C/P CSR anxiety severity, SCARED-C anxiety, and SDQ emotional difficulties, and higher CGAS functioning. | M.1 to M.5 |
| McLoone and Rapee (2012) | N = 152. Ages 7 to 12 years (M = 9.8). 62% girls. 10% of SCAS scores for their age group. Randomized to school-based GCBT, bibliotherapy w/o clinician support, or waitlist control. | At posttest and 12-month FU, school-based GCBT and bibliotherapy w/o clinician support led to lower SCAS-P anxiety and CALIS life interference than control. | M.1 to M.5 |
| Thirlwall et al. (2013) | N = 194. Ages 7 to 12 years. Mean age not reported. 52% girls. DSM GAD, Specific Phobia, SAD, SoP. Randomized to full guidance parent-delivered CBT, brief guidance parent-delivered CBT, or waitlist control. | At posttest, full guidance parent-delivered CBT led to lower CAIS-P interference and SMFQ low mood than brief guidance parent-delivered CBT and control. At posttest, participants in both treatment conditions were 85% more likely to have recovered from their ADIS-C/P CSR principal anxiety disorder than control, with full guided parent-delivered CBT leading to higher diagnostic recovery (50%) than brief guided parent-delivered CBT (39%). ADIS-C/P CSR diagnostic recovery rates at 6-month FU were comparable for both treatment conditions (76% for full guided, 71% for brief guided). Improvements for the intervention conditions were maintained at 3- to 5-year FU (Brown et al., 2017). | M.1 to M.5 |
| Waters et al. (2013) | N = 37. Ages 7 to 13 years (M = 9.60). 65% girls. DSM GAD, Specific Phobia, SAD, SoP. Randomized to ABMt-attention-toward-positive (ABMt-ATP) or ABMt attention training control (ABMt-ATC). | At posttest, ABMt-ATP led to lower ADIS-C/P CSR severity and higher attentional bias toward positive stimuli (via dot-probe task) than control. At posttest, 50% in ABMt-ATP no longer met ADIS-C/P CSR diagnostic criteria for principal anxiety disorder compared to 8% in control. No other between-group differences emerged on SCAS anxiety, SCAS-P anxiety, or CES-DC depression, with both conditions having led to lower SCAS anxiety, SCAS-P anxiety, and CES-DC depression at posttest. | M.1 to M.5 |
| Collins et al. (2014) | N = 317. Ages 9 to 10 years. Mean age not reported. 45% girls. Randomized to psychologist-led GCBT, teacher-led GCBT, or usual care. | Intervention conditions did not differ from one another at posttest. At posttest and 6-month FU, psychologist-led GCBT and teacher-led GCBT led to lower SCAS anxiety, CSI avoidance coping, and higher CSI problem solving coping and CSI social coping than control. At 6-month FU, psychologist-led GCBT led to lower SCAS anxiety than teacher-led GCBT and control, whereas teacher-led GCBT led to lower CSI avoidant coping was lower in teacher-led GCBT than psychologist-led GCBT and control. | M.1 to M.5 |
| Donovan and March (2014) | N = 52. Ages 3 to 6 years (M = 4.08). 54% girls. DSM GAD, Specific Phobia, SAD, SoP. Randomized to parent focused iCBT or waitlist control. | At posttest, 6-month, and 12-month FU, iCBT led to lower PAS anxiety, CBCL internalizing, and higher CGAS functioning than control. At posttest, ADIS-C/P CSR diagnostic recovery rates were 39.1% in iCBT and 25.9% in control; with iCBT ADIS-C/P CSR recovery rates improving to 70.6% in iCBT at 12-month FU. | M.1 to M.5 |
| Stallard et al. (2014) | N = 1,362. Ages 9 to 10 years. Mean age not reported. 51% girls. Randomized to school staff-led GCBT, health facilitator-led GCBT, or personal social and health education (PSHE) control. | At 12-month FU, health facilitator-led and school staff-led GCBT led to lower RCADS-C anxiety than control, with more pronounced changes occurring for those in school staff GCBT. At FU, health facilitator GCBT led to lower RCADS separation anxiety than school staff GCBT and control (Skryabina et al., 2016). | M.1 to M.5 |
| N = 99. Ages 9 to 10 years. Mean age not reported. Post-hoc subsample. ≥ 49 on RCADS anxiety. Randomized to school staff-led GCBT, health facilitator-led GCBT, or personal social and health education (PSHE) control. | Between-group differences were not evident for any outcome at posttest or 3-month FU. Both school staff-led and health facilitator-led GCBT led to lower RCADS-C anxiety. | M.1 to M.5 | |
| Wong et al. (2014) | N = 976. Ages 14 to 16 years. Mean age not reported. 70% girls. Randomized to iCBT for anxiety, iCBT for depression, or usual care. | Intervention conditions were not different from one another. At posttest, iCBT for anxiety led to reductions in GAD-7 generalized anxiety than control. iCBT for depression led to reductions in PHQ-5 depression than usual care. | M.1 to M.5 |
| Rodgers and Dunsmuir (2015) | N = 62. Ages 12 to 13 years. Mean age not reported. 69% girls. Randomized to GCBT or waitlist control. | At posttest and 4-month FU, GCBT led to lower SCAS and SCAS-P anxiety than control. No other between-group differences emerged on CRS school adjustment, with both GCBT and control having led to improvements in CRS school adjustment. | M.1 to M.5 |
| Ginsburg et al. (2015) | N = 136. Ages 6 to 13 years (M = 8.70). Parents met DSM criteria for GAD, Specific Phobia, SAD, SoP. Randomized to family-focused ICBT or information-monitoring control. | At posttest, 6-month, and 12-month FU, family-focused ICBT led to reduced ADIS-CSR severity than control. At 12-month FU, family-focused ICBT led to fewer ADIS anxiety disorder diagnoses than control (5.26% vs. 30.65%). Over time, family-focused ICBT also led to lower SCARED-P anxiety, CBCL anxiety/ depressive symptoms, and CBCL behavior problems than control (Pella et al., 2017). | M.1 to M.5 |
| Waters et al. (2015) | N = 59. Ages 6 to 17 years (M = 8.75). 53% girls. DSM GAD, Specific Phobia, SAD, SoP. Randomized to ABMt or waitlist control. | At posttest and 6-month FU, ABMt led to lower ADIS-C/P CSR severity, SCAS-P anxiety, SMFQ-P strengths and difficulties, CBCL internalizing, and higher CGAS functioning than control. At posttest, 35% no longer met ADIS-C/P CSR diagnostic criteria for principal anxiety disorder for ABMt vs. 7% in control. | M.1 to M.5 |
| Whiteside et al. (2015) | N = 14. Ages 7 to 14 (M = 10.20). 71% girls. DSM GAD, Specific Phobia, SAD, SoP. Randomized to ICBT or parent-coached exposure therapy (PC-Exp). | At posttest and 3-month FU, PC-Exp led to lower CBCL internalizing, CBCL externalizing, PARS anxiety, ADIS CSR severity, CGI severity, SCAS anxiety, SCAS-P anxiety, CSDS-P disability, and CATS negative cognitions than ICBT. | M.1 to M.4 |
| Calear et al. (2016) | N = 1,167. Ages 12 to 18 years (M = 14.86). 75% girls. Randomized to school supported iCBT, health service supported iCBT (e-GAD HS), or waitlist control. | Intervention conditions did not differ from one another. At posttest and 6-month FU, school supported iCBT led to lower SAS-A social anxiety, GAD-Y generalized anxiety, and higher WEMWBS psychological wellbeing than control. At 6-month FU, e-GAD HS led to higher WEMWBS wellbeing than control. No between-group differences were evident for any outcome at 12-month FU. | M.1 to M.5 |
| Calear et al. (2016) | N = 225. Ages 12 to 18 years (M = 14.86). 75% girls. Randomized to school-based iCBT or waitlist control. | No between-group differences were evident for any outcome at posttest or 3-month FU. | M.1 to M.5 |
| Fitzgerald et al. (2016) | N = 130. Ages 15 to 18 years (M = 15.94). 57% girls. SPAI-C ≥ 24. Randomized to ABMt or attention control training (ACT). | Between-group differences were not evident at posttest or 4-month FU. Both ABMt and ACT led to lower SPAI-C social anxiety and SCARED anxiety. | M.1 to M.5 |
| Infantino et al. (2016) | N = 24. Ages 5 to 11 years (M = 7.46). 54% girls. DSM GAD, Specific Phobia, SAD, SoP. Randomized to audio-based CBT or waitlist control. | At posttest and 3-month FU, audio-based CBT led to lower ADIS-C/P CSR severity, SCAS anxiety, and SCAS-P anxiety than control. At posttest, ADIS-C/P CSR diagnostic recovery rates for principal disorder were 58.3% for audio-based CBT and 16.7% for control. At FU, diagnostic recovery rates for audio-based CBT was 66.67%. | M.1 to M.5 |
| Morgan et al. (2016) | N = 51. Ages 3 to 6 years (M = 4.75). 49% girls. STSC >30. Randomized to parent-focused iCBT with clinician support or parent-focused iCBT without clinician support. | Intervention conditions did not differ from one another. At posttest, both conditions led to lower PAS-R anxiety, SDQ emotional difficulties, OAPA number of child anxiety diagnoses, and CALIS-PV life interference of anxiety. | M.1 to M.5 |
| Pergamin-Hight et al. (2016) | N = 67. Ages 6 to 18 years (M = 12.67). 57% girls. DSM SAD. Randomized to ABMt or ACT. | Between-group differences were not evident. Both ABMt and ACT led to lower ADIS-C/P social anxiety severity, SPAI-C social anxiety, dot probe response latencies, and higher dot probe accuracy at post and 3-month FU. | M.1 to M.5 |
| Pophillat et al. (2016) | N = 206. Ages 6 to 9 years. Mean age not reported. 51% girls. Randomized to GCBT or usual care control (health education classes). | At posttest, GCBT led to lower SCAS-P anxiety. No other between-group differences emerged. Both conditions led to lower ACES emotional skills. | M.1 to M.5 |
| Ruttledge et al. (2016) | N = 709. Ages 9 to 13 years (M = 10.83). 51% girls. Randomized to GCBT or usual care control (health education classes). | A posttest, GCBT led to improved BSC-Y self-concept, CES coping efficacy, and SCS school connectedness. GCBT also led to lower SCAS anxiety, however change was not significantly different than control. | M.1 to M.5 |
| Scholten et al. (2016) | N = 139. Ages 11 to 15 years (M = 13.27). 65% girls. SCAS ≥ 1 SD above the mean total anxiety symptoms or ≥ 1 SD above the mean on two SCAS subscales. Randomized to Biofeedback w/relaxation training video game (Dojo) or control video game. | Linear change of the top scoring SCAS subscale from pretest to posttest to FU was greater for Dojo than control. No between-group differences emerged for SCAS total anxiety. | M.1 to M.5 |
| Schoneveld et al. (2016) | N = 136. Ages 7 to 13 years (M = 9.95). 55% girls. SCAS ≥ 1 SD above the mean total anxiety symptoms or ≥ 1 SD above the mean on two SCAS subscales. Randomized to neurofeedback w/exposures and ABMt video game (Mindlight) or control video game. | Between-group differences were not evident at posttest and 3-month FU. Both Mindlight and control led to lower SCAS and SCAS-P anxiety. | M.1 to M.5 |
| Vigerland et al. (2016) | N = 93. Ages 8 to 12 years (M = 10.10). 51% girls. DSM GAD, PD, SAD, SoP, or Specific Phobia. Randomized to internet-delivered CBT with therapist-support or waitlist control. | At posttest, internet-delivered CBT led to lower ADIS-C/P CSR severity, SCAS-P anxiety, and improved CGAS functioning than control, with ADIS-C/P CSR severity and CGAS functioning improvements maintained at 3-month FU. No other between-group differences emerged on SCAS anxiety or QOLI-C quality of life. Internet-delivered CBT led to reduced SCAS anxiety and QOLI-C quality of life at posttest. | M.1 to M.5 |
| Ahlen et al. (2018) | N = 695. Ages 8 to 11 years (M = 9.60). 48% girls. Randomized to GCBT or waitlist control. | Between-group differences were not evident for any outcome at posttest and 12-month FU. | M.1 to M.5 |
| Cobham et al. (2017) | N = 61. Ages 7 to 14 years (M = 9.30). 49% girls. DSM Specific phobia, SAD, GAD, or SoP. Randomized to parent-focused GCBT or waitlist control. | At posttest, 3-, 6-, and 12-month FU, parent-focused intervention led to lower ADIS-C/P CSR severity, SCAS-P anxiety, SCAS anxiety, and CBCL internalizing than control. At posttest, 64.5% in parent-focused intervention were free from principal anxiety disorder vs. 16.2% in control based on ADIS-C/P CSR criterion. Parent-focused intervention ADIS-C/P CSR recovery rates improved to 84% at 12-month FU. | M.1 to M.5 |
| Creswell et al. (2017) | N = 136. Ages 5 to 12 (M = 9.21). 53% girls. Referred to mental health clinic for anxiety-related impairments. Randomized to brief guidance parent-delivered CBT or solution focused brief therapy (SFBT) | Between-group differences were not evident for any outcome at posttest or 3-month FU. Both brief guidance parent-delivered CBT and SFBT led to higher CGI improvement scores and lower KFQ-C fears, SCAS anxiety, SCAS-P anxiety, and ADIS-C/P CSR. | M.1 to M.5 |
| De Voogd et al. (2017) | N = 108. Ages 11 to 19 years (M = 14.45). 67% girls. SCARED >16 anxiety symptoms and/or CDI >7 depressive symptoms. Randomized to internet-based visual search ABMt (VS-ABMt), VS placebo-training, or no intervention control. | At posttest, VS-ABMt led to lower EVST attentional bias and Recognition Task interpretation bias than controls. No other between-group differences emerged on SCARED anxiety, CDI-C depression, RSES self-esteem, PTQ perseverative thinking, and SDQ-P strengths and difficulties, with all conditions having led to improvements in these outcomes at posttest and 6-month FU. | M.1 to M.5 |
| Kato and Shimizu (2017) | N = 74. Ages 8 to 9 years. Mean age not reported. 43% girls. Randomized to GCBT or no intervention control. | At posttest, GCBT led to lower SCAS-P anxiety. No other between-group differences emerged on SCAS anxiety, DSRS-depression, Hope, or SDQ-P total difficulties. | M.1 to M.5 |
| Morgan et al. (2017) | N = 433. Ages 3 to 6 years (M = 4.80). 53% girls. STSC >30. Randomized to parent-focused iCBT (with clinician support as needed) or waitlist control. | At posttest, parent-focused internet-based CBT led to lower PAS-R anxiety, CALIS life interference, and fewer PAS-R anxiety disorder diagnoses than control (40% vs. 54%, respectively). | M.1 to M.5 |
| Schoneveld et al. (2017) | N = 174. Ages 7 to 12 years (M = 9.97). 59% girls. Randomized to cognitive-behavioral neurofeedback training video game video game (Mindlight) or GCBT. SCAS ≥ 1 SD above the mean total anxiety symptoms or ≥ 1 SD above the mean on two SCAS subscales. | Between-group differences were not evident. Both Mindlight and GCBT led to lower SCAS and SCAS-P anxiety at posttest, 3-month and 6-month FU. | M.1 to M.5 |
| Weersing et al. (2017) | N = 185. Ages 8 to 17 (M = 11.30). 58% girls. DSM GAD, Specific Phobia, SAD, SoP. Randomized to brief behavioral therapy (BBT) or assisted referral to care (ARC). | At posttest, BBT led to lower CGI severity, PARS anxiety, improvements in CGAS functioning, and higher rates of CGI clinical improvement (56.8% vs. 28.2%) than ARC. | M.1 to M.5 |
| Bayer et al. (2018) | N = 545. Ages 3 to 6 years (M = 4.55). 48% girls. Australian Temperament Project approach/inhibition >30. Randomized to parent-focused GCBT or treatment as usual control (access to community mental health services). | Between-group differences were not evident. Both parent-focused GCBT and control led to lower SDQ internalizing symptoms and fewer DSM anxiety disorder diagnoses based on ADIS-C/P criteria. | M.1 to M.5 |
| Chavira et al. (2018) | N = 31. Ages 8 to 13 years (M= 11.25). Mean age and sex not reported. DSM Specific phobia, SAD, GAD, or SoP. Randomized to parent-mediated CBT bibliotherapy telephone-delivered, therapist-assisted bibliotherapy or parent-mediated CBT bibliotherapy minimal contact, self-directed. | At posttest, ADIS-C/P CSR recovery rates were 50% in telephone-therapist and 36% for self-directed. | M.1 to M.5 |
| Liu et al. (2018) | N = 84. Ages 9 to 12 years. Mean age and sex not reported. Met criteria for behavioral inhibition per BIQ. Randomized to ABMt or attention control training. | At posttest, ABMt led to lower C-DISC-IV separation anxiety than control. ABMt also led to reduced amygdala and insulate activation and enhanced activation in ventrolateral prefrontal cortex relative to control via fMRI data. | M.1 to M.5 |
| Ollendick et al. (2018) | N = 58. Ages 12 to 16 years (M = 14.29). 71% girls. DSM SAD. Randomized to ABMt or ACT. | At posttest, ABMt led to lower SCARED-C social anxiety than control. No other between-group differences emerged on SCARED-P social anxiety, EATQ-R-P attention control, or dot probe threat bias. Both ABMt and control led to lower SCARED-P social anxiety at posttest. | M.1 to M.5 |
| Schleider and Weisz (2018) | N = 96. Ages 12 to 15 years (M = 13.33) 55% girls. RCADS-P ≥ 84th percentile, has school-based accommodations for internalizing symptoms, or sought treatment for anxiety in past 3 years. Randomized to computer-based growth mind-set intervention (GMI) or computer-based supportive-therapy. | GMI led to lower CDI-P depression, SCARED-P anxiety, PCSC behavioral control, and CDI-C depression than computer-based supportive-therapy. | M.1 to M.5 |
| Suveg et al. (2018) | N = 92. Ages 7 to 12 years. Mean age not reported. 42% girls. DSM GAD, SAD, SoP. Randomized to emotion-focused CBT (ECBT) or ICBT. | Intervention conditions did not differ from one another. At posttest, both ECBT and ICBT led to lower ERC emotion regulation, ERC emotion dysregulation, ERC anger regulation, CEMS anger, sadness, and worry dysregulation, ADIS-C/P CSR severity, and CGI severity. At posttest, 72% in ECBT and 74% in ICBT no longer met ADIS-IV diagnostic criteria for their principal anxiety disorder. | M.1 to M.5 |
| Pina et al. (2020) | N = 109. Ages 8 to 12 (M = 9.64). 78% girls. SCAS ≥ 42 anxiety symptoms. Randomized to GCBT with social skills training or active control. | At 12-month FU, GCBT led to higher SEQSS self-efficacy for managing anxiety, SSIS-RS social competence, and lower CNCEQ cognitive interpretation biases than control. | M.1 to M.5 |
| Phobias (n = 10) | |||
| Sheslow et al. (1983) | N = 32. Ages 4 to 5 years. Mean age not reported. 50% girls. Darkness phobia as measure by <8 seconds of darkness tolerance. Randomized to graduated exposure, verbal coping skills, graduated exposure plus verbal coping skills, or contact-only control. | At posttest, graduated exposure condition and graduated exposure plus verbal coping skills conditions led to improved BAT dark tolerance than verbal coping skills and control, with more pronounced improvements occurring for graduated exposure condition. | M.1 to M.4 |
| Menzies and Clarke (1993) | N = 48. Ages 3 and 8 years (M = 5.50). BRS <15 and water phobic (no DSM diagnosis). Randomized to in vivo exposure plus vicarious exposure (IWE), vicarious exposure (VE), in vivo exposure (IVE), or assessment only control. | At posttest, IWE and IVE led to lower CWP water phobia, PCWP water phobia, OR phobic reactions, and greater improvements in BRS approach behavior and ability than control. At FU, IWE, VE, and IVE led to further reductions in OR phobic reactions, and improvements in BRS approach behavior and ability than control. At FU, IVE demonstrated poorer effect maintenance and improvement on all outcomes than IWE. | M.1 to M.5 |
| Cornwall et al. (1996) | N = 24. Ages 7 to 10 years (M = 8.25). DSM Specific Phobia (darkness). Randomized to individual emotive imagery therapy (EAT) or waitlist control. | At posttest and FU, EAT led to improvements in behavioral responses to darkness tolerance and lower FSSC-R fears, RCMAS anxiety, DFBQ darkness fear behavior than control. | M.1 to M.5 |
| Muris et al. (1998) | N = 28. Ages 8 to 17 years (M = 12.58). 100% girls. DSM Specific Phobia (spiders). Randomized to EMDR, in vivo exposure (IVE), or computerized exposure control. | At posttest and FU, IVE led to lower SPQ-C spider fear, SAM fear/arousal, BAT state anxiety, and BAT spider avoidance than EMDR and control. At posttest, EMDR led to lower SPQ-C spider fear than control. | M.1 to M.4 |
| Dewis et al. (2001) | N = 28. Ages 10 to 17 years. Mean age not reported. 64% girls. DSM Specific Phobia (spiders). Randomized to live graded exposure (LGE), computer-aided vicarious exposure (CAVE), or waitlist control. | At posttest and 1-month FU, LGE and CAVE had lower SPQ-C spider phobia, PT phobic severity, BAT approach avoidance, and SUDS than control. At posttest, LGE improved more than CAVE on SPQ-C and SUDS and led to greater reductions in SPQ-C spider phobia and PT phobic severity than CAVE at FU. | M.1 to M.4 |
| Öst et al. (2001) | N = 60. Ages 7 to 17 years (M = 11.70). 61% girls. DSM Specific Phobia. Randomized to child only one session treatment for specific phobia (OST), parent present OST, or waitlist control. | At posttest and 1-year FU, child only OST and parent present OST led to lower BAT avoidance than waitlist control, with greater improvements emerging for child only OST. No other between-group differences emerged on FSSC-R fears, RCMAS anxiety, CASI anxiety sensitivity, STAIC trait anxiety, STAIC state anxiety, and CDI depression. Both child-only OST and parent present OST led to lower FSSC-R fear, RCMAS anxiety, STAIC anxiety, and CASI anxiety sensitivity at post and FU. | M.1 to M.5 |
| Ollendick et al. (2009) | N = 196. Ages 7 to 16 years (M = 11.00). 55% girls. DSM Specific Phobia. Randomized to OST, education support treatment (EST), or waitlist control. | At posttest, OST led to lower BAT SUDS and ADIS-C/P CSR than EST and control. At 6-month FU, OST led to lower ADIS-C/P CSR severity than EST and control. Both OST and EST led to lower CBCL anxiety/depression, MASC anxiety, and FSSC-R fears than control at posttest and FU; OST and EST did not differ from one another for these outcomes. At posttest, ADIS-C/P CSR diagnostic recovery rates were 55% in OST, 23% in EST, and 2% in control; recovery rates were similar at FU (52% in OST and 21% in EST). | M.1 to M.5 |
| Flatt and King (2010) | N = 43. Ages 7 to 17 years (M = 11.23). 60% girls. DSM Specific Phobia. Randomized to OST, psychoeducation, or waitlist control. | Intervention conditions did not differ from one another. At posttest and 1-year FU, OST and Psychoeducation led to lower BAT approach avoidance and FSSC-II tearfulness, as well as higher SEQ-SP self-efficacy than control. | M.1 to M.5 |
| Waters et al. (2014) | N = 37. Ages 6 to 17 years (M = 10.56) 57% girls. DSM Specific Phobia. Randomized to Attention training toward positive stimuli plus OST (ATP+OST) or attention control training plus OST (ACT+OST). | At posttest and 3-month FU, ATP+OST led to lower danger expectancies to fear stimuli and greater bias toward positive stimuli at posttest than ACT+OST. No other between-group differences emerged on SCAS anxiety, SCAS-P anxiety, and SMFQ-C/P depression, with both ATP+OST and ACT+OST having led to lower SCAS anxiety, SCAS-P anxiety, and SMFQ-C/P depression at posttest and FU. | M.1 to M.5 |
| Ollendick et al. (2015) | N = 97. Ages 6 to 15 years. Mean age not reported. 52% girls. DSM Specific Phobia. Randomized to OST or parent-augmented OST (A-OST). | Intervention conditions did not differ from one another at posttest or 1-month FU. Both OST and A-OST led to lower ADIS-C/P CSR severity and higher PIR and CIR anxiety improvement. At 6-month FU, OST resulted in marginally superior ADIS-C/P diagnostic recovery ratings than A-OST (67.39% for OST and 49.02% for A-OST). | M.1 to M.5 |
ACES = Assessment of Children’s Emotional Skill; ADIS-C/P = Anxiety Disorders Interview Schedule for DSM-IV; ADIS-C/P CSR = Clinician Severity Rating; ASP = Ambiguous Situations Protocol; AWS = Adolescent Wellbeing Scale; BAI = Beck Anxiety Inventory; BASC-PRS = Behavior Assessment System for Children–Parent Rating Scales; BAT = Behavioral Assessment Test; BERS-P = Behavioral and Emotional Rating Scale (Parent); BERS-T = Behavioral and Emotional Rating Scale (Teacher); BHS = Beck Hopelessness Scale; BIQ = Behavioral Inhibition Questionnaire; BRS = Behavior Response Scale; BSC-Y = Beck Self-Concept Inventory for Youth; C-DISC-IV = Diagnostic Interview Schedule for Children; CALIS = Child Anxiety Life Interference Scale; CALIS-P = Child Anxiety Life Interference Scale (Parent); CALIS-PV-P = Child Anxiety Life Interference Scale – Preschool Version (Parent); CASI = Child Anxiety Sensitivity Index; CATS = Children’s Automatic Thoughts Scale; CBCL = Child Behavior Checklist; CDI = Children’s Depression Inventory; CEMS = Children’s Emotion Management Scales; CES = Coping Efficacy Scale; CES-DC = Center for Epidemiological Studies Depression Scale; CGAS = Children’s Global Assessment Scale; CGI = Clinical Global Impressions; CIR = Child Improvement Rating; CNCEQ = Children’s Negative Cognitive Error Questionnaire; CRS = Child Rating Scale; CSDS-P = Child Sheehan Disability Scale (Parent); CSI = Coping Strategy Indicator; CWP = Water Phobia Survey Schedule; DFBQ = Darkness Fear Behavior Questionnaire; DSRS-C = Depression Self Rating Scale for Children; EATQ-R-P = Early Adolescent Temperament Questionnaire-Revised Short Form; ERC = Emotion Regulation Checklist; FSSC-R = Fear Survey Schedule for Children-Revised; GAD = Generalized Anxiety Disorder; GAD-7 = Generalized Anxiety Disorder – Seven item scale; Hope = Children’s Hope Scale; KFQ-C = Koala Fear Questionnaire – child report; LSAS – RS = Liebowitz Social Anxiety Scale-Revised; MADRS-S = Montgomery-Asberg Depression Rating Scale-Self Report; MASC = Multidimensional Anxiety Scale for Children; MASC-P = Multidimensional Anxiety Scale for Children (Parent); MES = Motivation and Engagement Scale; OAPA = Online Assessment of Preschool Anxiety; OR = Overall Reaction; PAS = Preschool Anxiety Scale; PAS-R = Preschool Anxiety Scale-Revised; PCSC = Perceived Control Scale for Children; PCWP = Water Phobia Survey Schedule (Parent); PHQ = Patient Health Questionnaire; PIR = Parent Improvement Rating; PT = Phobic Target; PTQ = Perseverative Thinking Questionnaire; QOLI-C Quality of Life Inventory-Child Version; RCADS = Revised Children’s Anxiety and Depression Scale; RCMAS = Revised Children’s Manifest Anxiety Scale; RSEI = Rosenberg Self-Esteem Inventory; RSES = Rosenberg Self-Esteem Scale; RTAS = Revised Test Anxiety Scale; SAD = Separation Anxiety Disorder; SAM = Self-Assessment Manikin; SASA = Social Anxiety Scale for Adolescents-Avoidance; SASC-R = Social Anxiety Scale for Children-Revised; SCARED = Screen for Child Anxiety Related Emotional Disorders; SCARED-P = Screen for Child Anxiety Related Emotional Disorders (Parent); SCAS = Spence Children’s Anxiety Scale; SCAS-P = Spence Children’s Anxiety Scale SCAS-P (Parent); SCBE = Social Competence and Behavior Evaluation; SCS = School Connectedness Scale; SDQ-P = Strengths and Difficulties Questionnaire (Parent); SEI = Self Esteem Inventory; SEQ-SP Self-Efficacy Questionnaire for Specific Phobias; SEQSS = Self Efficacy Questionnaire for School Situations; SMFQ = Short Mood and Feelings Questionnaire; SMFQ-P = Short Mood and Feelings Questionnaire (Parent); SoP = Social Phobia; SOSI = Symptoms of Stress Inventory; SPAI-C = Social Phobia and Anxiety Inventory; SPQ-C = Spider Phobia Questionnaire for Children; SPSQ-C = Social Phobia Screening Questionnaire for Children; SQC = Schema Questionnaire for Children; SSIS-RS = Social Skills Improvement System-Rating Scales; STAIC = State-Trait Anxiety Inventory for Children; STAXI = State Trait Anger Expression Inventory; STSC = Short Temperament Scale for Children; STSC-P = Short Temperament Scale for Children (Parent); SUDS = Subjective Units of Distress; TABC-R-P = Temperament Assessment Battery for Children-Revised (Parent); TASC = Test Anxiety Scale for Children; TRF = Teacher’s Report Form; WEMWBS = Warwick-Edinburgh Mental Wellbeing Scale; YSR = Youth Self Report.
K = number of studies; N = sample size; g = weighted mean effect size; SDg = weighted standard deviation of g; 95% CI = 95% confidence interval; FSN = Fail-Safe N, which is the number of samples with an effect size of zero that should have been left out in order to reduce estimated effect size to non-significance; Qw = Variability among effect sizes; Pre to follow-up is average of 8.88 months; *p <.05, ** p <.01, ***p <.001.