Child anxiety in mental health care: Closing the gaps between research and clinical practice

In this dissertation about child anxiety in mental health care, three gaps between research and everyday clinical practice were addressed.
Despite the high prevalence of anxiety disorders in children, only a minority is referred to mental health care. It was found that more severe impairment in the daily functioning of the child as a result of their anxiety disorders is associated with referral to mental health care. Family variables were no predictors.
Focussing on anxiety-enhancing parenting and family functioning is believed to increase child anxiety treatment effectiveness and to facilitate treatment generalization. It was found that only a minority of the parenting and family variables differed between referred clinically anxious families versus control families. Anxiety-enhancing parenting and family functioning did improve after both family-focused cognitive behavioural therapy (CBT) and child-focused CBT, with no differences between treatments. Good family relational functioning at post-treatment was the only family variable that was consistently associated with more improvement on anxiety measurements for adolescents.
CBT for child anxiety is considered effective. However, circumstances in research trials might be different to real clinical practice. It was found that CBT was not only effective within the context of a research trial, but also in daily clinical practice. Improvements on anxiety symptoms were similar. More general experience in mental health care and with prior anxiety cases of the therapist were associated with better treatment outcomes. No association were found between anxiety improvement and therapist’s pre-treatment training, supervision and treatment adherence.
Results and their implications are discussed.