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One session treatment (OST) is equivalent to multi-session cognitive behavioral therapy (CBT) in children with specific phobias (ASPECT): results from a national non-inferiority randomized controlled trial

Wright, Barry; Tindal, L; Scott, Alexander J.; Lee, Ellen; Cooper, Cindy; Biggs, Katie; Bee, Penny; Wang, Han‐I; Gega, Lina; Hayward, Emily; Solaiman, Kiera; Teare, M. Dawn; Davis, Thompson; Wilson, Jon; Lovell, Karina; McMillan, Dean; Barr, Amy; Edwards, Hannah; Lomas, Jennifer; Turtle, Chris; Parrott, Steve; Teige, Catarina; Chater, Tim; Ali, Shezhad; Parkinson, Sarah; Gilbody, Simon; Marshall, David; Hargate, Rebecca

One session treatment (OST) is equivalent to multi-session cognitive behavioral therapy (CBT) in children with specific phobias (ASPECT): results from a national non-inferiority randomized controlled trial Thumbnail


Authors

Barry Wright

L Tindal

Ellen Lee

Cindy Cooper

Katie Biggs

Penny Bee

Han‐I Wang

Lina Gega

Emily Hayward

Kiera Solaiman

M. Dawn Teare

Thompson Davis

Jon Wilson

Karina Lovell

Dean McMillan

Amy Barr

Hannah Edwards

Jennifer Lomas

Chris Turtle

Steve Parrott

Catarina Teige

Tim Chater

Shezhad Ali

Sarah Parkinson

Simon Gilbody

David Marshall

Rebecca Hargate



Abstract

Background5%–10% children and young people (CYP) experience specific phobias that impact daily functioning. Cognitive Behaviour Therapy (CBT) is recommended but has limitations. One Session Treatment (OST), a briefer alternative incorporating CBT principles, has demonstrated efficacy. The Alleviating Specific Phobias Experienced by Children Trial (ASPECT) investigated the non‐inferiority of OST compared to multi‐session CBT for treating specific phobias in CYP.MethodsASPECT was a pragmatic, multi‐center, non‐inferiority randomized controlled trial in 26 CAMHS sites, three voluntary agency services, and one university‐based CYP well‐being service. CYP aged 7–16 years with specific phobia were randomized to receive OST or CBT. Clinical non‐inferiority and a nested cost‐effectiveness evaluation was assessed 6‐months post‐randomization using the Behavioural Avoidance Task (BAT). Secondary outcome measures included the Anxiety Disorder Interview Schedule, Child Anxiety Impact Scale, Revised Children's Anxiety Depression Scale, goal‐based outcome measure, and EQ‐5DY and CHU‐9D, collected blind at baseline and six‐months.Results268 CYPs were randomized to OST (n = 134) or CBT (n = 134). Mean BAT scores at 6 months were similar across groups in both intention‐to‐treat (ITT) and per‐protocol (PP) populations (CBT: 7.1 (ITT, n = 76), 7.4 (PP, n = 57), OST: 7.4 (ITT, n = 73), 7.6 (PP, n = 56), on the standardized scale‐adjusted mean difference for CBT compared to OST ‐0.123, 95% CI −0.449 to 0.202 (ITT), mean difference −0.204, 95% CI −0.579 to 0.171 (PP)). These findings were wholly below the standardized non‐inferiority limit of 0.4, suggesting that OST is non‐inferior to CBT. No between‐group differences were found on secondary outcomes. OST marginally decreased mean service use costs and maintained similar mean Quality Adjusted Life Years compared to CBT.ConclusionsOne Session Treatment has similar clinical effectiveness to CBT for specific phobias in CYP and may be a cost‐saving alternative.

Journal Article Type Article
Acceptance Date Apr 26, 2022
Online Publication Date Sep 1, 2023
Publication Date Aug 1, 2022
Journal Journal of Child Psychology and Psychiatry
Print ISSN 0021-9630
Publisher Wiley
Volume 64
Issue 1
Pages 39-49
DOI https://doi.org/10.1111/jcpp.13665
Keywords Psychiatry and Mental health, Developmental and Educational Psychology, Pediatrics, Perinatology and Child Health
Publisher URL https://acamh.onlinelibrary.wiley.com/doi/10.1111/jcpp.13665

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