Summary: A long-term follow-up suggests a single course of treatment may not keep most young people with anxiety well over time.
Source: Kim Krieger — UConn
Only about one in five young people treated for anxiety remain symptom-free in the long term, according to researchers at UConn Health publishing in the Journal of the American Academy of Child and Adolescent Psychiatry.
Golda Ginsburg, a psychologist at UConn Health, says the finding is sobering. “When so few children and adolescents remain non-symptomatic after receiving our best available treatments, it challenges the way we think about care,” she explains. Ginsburg and colleagues suggest that routine mental health checkups and ongoing monitoring may produce better long-term outcomes than a single, time-limited intervention.
The study followed 319 young people, ages 10 to 25, who had been diagnosed with separation anxiety disorder, social anxiety disorder, and/or generalized anxiety disorder at multiple sites in California, North Carolina, Maryland, and Pennsylvania. Participants originally received evidence-based treatment in the Child/Adolescent Anxiety Multimodal Study (CAMS): 12 weeks of cognitive behavioral therapy (CBT), sertraline (generic Zoloft), a combination of CBT and sertraline, or placebo. After that trial, researchers continued to assess participants annually for four years in a follow-up study called CAMELS. These yearly assessments measured anxiety outcomes but did not provide ongoing treatment.
Because participants were reassessed every year for four years, the researchers could track fluctuating trajectories: those who recovered and stayed well, those who recovered then relapsed, those who were continuously ill, and those who recovered for the long run. Only about 20–22 percent of participants achieved stable remission—defined as the absence of all DSM-IV anxiety disorders at every follow-up year. Roughly half experienced at least one relapse during the follow-up period, and about 30 percent were persistently symptomatic, meeting diagnostic criteria at every assessment.
Certain factors were associated with worse long-term outcomes. Female participants were more likely than males to be chronically ill. Additional predictors of persistent anxiety included experiencing more negative life events during the follow-up, poor family communication, and an initial diagnosis of social phobia (social anxiety disorder). Conversely, participants who responded well to acute treatment were less likely to remain chronically ill; an early positive response appears to reduce the risk of long-term disability.
Importantly, the type of acute treatment did not predict long-term remission status. Outcomes were similar across CBT, sertraline, and their combination, suggesting that when access to one treatment is limited (for example, when a trained CBT therapist is not available), medication may offer comparable long-term benefit. Families and clinicians should consider both access and patient preference when choosing an evidence-based intervention.
The study highlights the important role of family support and positive communication in improving outcomes. Ginsburg recommends that caregivers stay engaged during treatment: ask the therapist why a particular intervention is recommended and whether it’s evidence-based, confirm the therapist’s CBT training if CBT is used, and discuss concrete ways to reinforce skills learned in therapy between sessions. At the same time, families and clinicians should recognize that a single episode of treatment may not be sufficient to maintain recovery over several years.
“If we can get them well, how do we keep them well?” Ginsburg asks. “We need a different model for mental health—one that includes regular checkups and ongoing monitoring so we can intervene when symptoms begin to return.”
Publisher: Organized by NeuroscienceNews.com
Image source: Adapted from the UConn news release
Original research: Results From the Child/Adolescent Anxiety Extended Long-Term Study (CAMELS): Primary Anxiety Outcomes. Golda S. Ginsburg, PhD, Emily M. Becker-Haimes, PhD, Courtney Keeton, PhD, Philip C. Kendall, PhD, ABPP, Satish Iyengar, PhD, Dara Sakolsky, MD, Anne Marie Albano, PhD, Tara Peris, PhD, Scott N. Compton, PhD, John Piacentini, PhD, ABPP. Journal of the American Academy of Child and Adolescent Psychiatry. Published May 3, 2018.
DOI: 10.1016/j.jaac.2018.03.017
Results From the Child/Adolescent Anxiety Extended Long-Term Study (CAMELS): Primary Anxiety Outcomes
Objective
This multisite follow-up study reports anxiety outcomes across four years for youth originally enrolled in CAMS. The primary aims were to estimate rates of stable remission—defined as the absence of all DSM-IV anxiety disorders across all follow-up years—and to identify predictors of remission. Predictors examined included acute treatment response, treatment assignment, baseline child and family variables, and interim negative life events.
Method
Data came from 319 youths (ages 10.9–25.2 years; mean 17.12 years) originally diagnosed with separation anxiety disorder, social anxiety disorder, and/or generalized anxiety disorder. Participants received annual independent evaluations using age-appropriate versions of the Anxiety Disorders Interview Schedule and completed questionnaires on family functioning, life events, and mental health service use.
Results
About 22% of participants achieved stable remission, 30% remained chronically ill, and 48% were classified as relapsers. Acute treatment responders were less likely to be chronically ill (odds ratio = 2.73; 95% confidence interval = 1.14–6.54; p < .02). Treatment assignment (CBT, sertraline, combination, or placebo) was not associated with remission status across the follow-up. Several baseline factors, including male gender, predicted stable remission.
Conclusion
An early positive response to treatment appears to lower the risk of chronic anxiety, and identified predictors can help clinicians tailor interventions to youth at greatest risk for persistent illness. These findings support models of care that include ongoing monitoring and follow-up rather than relying solely on a single, time-limited intervention.
Clinical Trial Registration Information
Child and Adolescent Anxiety Disorders (CAMS). ClinicalTrials.gov identifier NCT00052078.