Child versus family cognitive-behavioral therapy in clinically anxious youth: an efficacy and partial effectiveness study

J Am Acad Child Adolesc Psychiatry. 2008 Dec;47(12):1384-94. doi: 10.1097/CHI.0b013e318189148e.


Objective: The efficacy and partial effectiveness of child-focused versus family-focused cognitive-behavioral therapy (CBT) for clinically anxious youths was evaluated, in particular in relation to parental anxiety disorders and child's age.

Method: Clinically referred children with anxiety disorders (N = 128) and their parents were randomly assigned to child or family CBT and evaluated at pretreatment, posttreatment, and 3-month follow-up. Twenty-five families were measured before and after a 2- to 3-month waitlist period.

Results: None of the waitlisted children recovered from their anxiety disorders. In contrast, 41% of the treated children no longer met criteria for any anxiety disorder after CBT, and 52% demonstrated continued improvement at the 3-month follow-up. Significantly more children were free of anxiety disorders (53%) in the child CBT condition compared with family CBT condition (28%) at posttreatment, whereas at 3-month follow-up, the superior effect of child CBT was no longer significant. Similar results were obtained from the questionnaire measures. Both child and family CBT were less effective if parents had an anxiety disorder themselves. On some of the measures, child CBT was superior if parents had anxiety disorders themselves, whereas family CBT was superior if parents had no anxiety disorders. Finally, younger children had better outcomes than older children, regardless of the treatment condition.

Conclusions: Overall, child CBT seems slightly more beneficial than family CBT. Because this study was conducted in a clinical setting with clinically referred children, results indicate partial effectiveness for child CBT.

Publication types

  • Comparative Study
  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Anxiety Disorders / diagnosis
  • Anxiety Disorders / psychology
  • Anxiety Disorders / therapy*
  • Child
  • Cognitive Behavioral Therapy / methods*
  • Comorbidity
  • Family Therapy / methods*
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Mood Disorders / diagnosis
  • Mood Disorders / psychology
  • Mood Disorders / therapy
  • Personality Assessment
  • Phobic Disorders / diagnosis
  • Phobic Disorders / psychology
  • Phobic Disorders / therapy