A Pilot Study of Computer-Assisted Cognitive Behavioral Therapy for Childhood Anxiety in Community Mental Health Centers.

Anxiety disorders among children are common, disabling, and run a chronic course without treatment. Cognitive behavioral therapy (CBT) has shown robust efficacy for childhood anx- iety. However, dissemination of CBT into community mental health centers (CMHCs) is limited. Computer-assisted CBT (CCBT) programs have been developed to improve dissem- ination by providing a structured treatment format that allows therapists to reliably deliver evidence-based treatments with fidelity. In this pilot study involving therapists with limited CBT experience, the effectiveness, feasibility, and acceptability of a CCBT program, Camp Cope-A-Lot (Khanna & Kendall, 2008b), were examined in three CMHCs. Seventeen youth ages 7-13 years and diagnosed with a primary anxiety disorder were enrolled. Assessments were conducted by a rater not involved in treatment at baseline and posttreatment. Significant reductions in anxiety severity and impairment were demonstrated at the posttreatment assess- ment. High levels of family satisfaction were reported. These results provide preliminary support for the effectiveness of a computer-assisted treatment into CMHCs and warrant rep- lication in a controlled setting.Keywords: children; anxiety; cognitive behavioral therapy; dissemination; treatment; psychotherapyAnxiety disorders are among the most common childhood psychiatric disorders, affecting 10%-20% of children and adolescents (Achenbach, Howell, McConaughy, & Stanger, 1995; Costello, Egger, & Angold, 2005). Elevated anxiety during childhood can negatively impact several domains of the child's life, including academic (King & Ollendick, 1989; Langley, Bergman, McCracken, & Piacentini, 2004), social (Chansky & Kendall, 1997), and family func- tioning (Bodden, Dirksen, & Bogeis, 2008; Ginsburg, Siqueland, Masia-Warner, & Hedtke, 2004). Left untreated, anxiety symptoms are typically unremitting and increase the risk of sustained anxiety during adulthood, or developing a co-occurring mood or substance abuse disorder (e.g., Ferdinand & Verhulst, 1995; Kendall, Safford, Flannery-Schroeder, & Webb, 2004; Pine, Cohen, Gurley, Brook, & Ma, 1998).Given the potential negative outcomes associated with childhood anxiety, it is impor- tant that timely and effective treatment is delivered. Cognitive behavioral therapy (CBT) is an evidenced-based psychotherapeutic treatment that has proven efficacy in childhood anx- iety (e.g., Kendall, Hudson, Gosch, Flannery-Schroeder, & Suveg, 2008; Kendall et al., 2004; Walkup et al., 2008). However, dissemination outside of specialty clinics into community set- tings is limited. As a result, the preponderance of available psychosocial treatment options at settings with high patient volumes such as community mental health centers (CMHCs) lack empirical support (Collins, Westra, Dozois, & Burns, 2004; Goisman, Warshaw, & Keller, 1999) contributing to attenuated treatment outcomes. Yet, efforts to transport effective psychoso- cial interventions into CMHCs have met with mixed results. Several studies support the effi- cacy of evidence-based treatments-including CBT for mood and anxiety disorders-relative to usual care provided in CMHCs, although with smaller effect sizes than those seen in ran- domized control trials (Weersing & Weisz, 2002; Weisz, Jensen-Doss, & Hawley, 2006). In a meta-analysis of randomized control trials that compared CBT for various disorders (e.g., de- linquency/conduct problems, depression, and anxiety) to the usual care received in CMHCs, Weisz et al. (2006) found an effect size of 0.3 in favor of evidenced-based practices, including CBT, which is impressive given the complexity associated with cases seen in CMHCs and that usual care included active intervention. In contrast, some studies of transporting evidenced- based practices into CMHCs have found that CBT does not outperform usual care in treating anxious (Southam-Gerow et al. …