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Long Term Follow up in Children with Anxiety Disorders Treated with Acceptance and Commitment Therapy or Cognitive Behavioral Therapy: Outcomes and Predictors

Karen Hancock, Jessica Swain, Cassandra Hainsworth, Siew Koo and Angela Dixon

Objective: Anxiety disorders in children are the most prevalent of mental health conditions, but also the most treatable. However, a significant number do not benefit from treatment and these places them at risk for future psychiatric disturbance. Whilst Acceptance and Commitment Therapy (ACT) is gaining rapid evidence for its utility in treating a variety of disorders, research in children and adolescence is at an early stage. This paper reports on 2 year follow-up (2YFU) outcomes of the first randomized controlled trial of ACT and traditional cognitive behavioral therapy (CBT) in children with a DSM-IV diagnosis of anxiety disorders. Method: Of the 111 children from urban Sydney, Australia who completed treatment (10-week group-based program of ACT or CBT). A total of 79 (40 ACT and 39 CBT) were assessed at 2YFU. Pre-treatment, posttreatment, 3 months (3MFU) and 2YFU assessments included clinician/self/parent-reported measures of anxiety, anxiety-related quality of life (QOL) and acceptance/defusion outcomes. Several baseline predictors of anxiety outcome were also examined. Results: Positive findings were obtained for both ACT and CBT in terms of long-term maintenance of gains. Across measures, highly significant improvements observed at post and 3MFU were maintained at 2YFU. At post approximately one-third of participants in both treatment groups no longer met criteria for any anxiety disorder, with further improvement evident at 3MFU. Continued improvement was observed at 2YFU, with 45% of ACT and 60% of CBT participants diagnosis free (non-significant difference). Both completer and intention to treat analyses found ACT and CBT to produce similar outcomes. The only significant predictors in the short-term were pre-treatment severity and age. At 2YFU, no significant predictors were identified. However, most participants were in the severe anxiety category pre-treatment, limiting the exploration of severity as a predictor. Conclusion: Both ACT and CBT have shown similar long terms benefits for children with anxiety disorders. There was no clear or strong pattern of baseline predictors of outcomes. Further research is needed to explore this area.