The efficacy of manualized Cognitive Behavior Therapy conducted by student-therapists treating Danish youths with anxiety using a benchmark comparison

	Youths in ST group (n= 54)	Youths in PT group (n= 56)
Mean age in years (SD)	10.18 (1.46)	11.82 (2.49)
Males (%)	32 (59.3)	25 (44.6)
On psychopharmacological medication	3 (6.7)	2 (4.5)
Primary diagnosis (%)
SAD	24 (44.4)	15 (26.8)
GAD	15 (27.8)	14 (25.0)
SoP	7 (13.0)	7 (12.5)
SP	6 (11.1)	12 (21.4)
OCD	1 (1.9)	4 (7.1)
AP without PD	1 (1.9)	4 (7.1)
CSR mean for primary diagnosis	6.33 (0.75)	6.09 (1.07)
CSR mean for all diagnosis	4.60 (1.33)	5.32 (0.95)
Comorbid diagnoses (%)
Anxiety disorders	50 (92.6)	47 (83.9)
Externalizing disorders	6 (11.2)	6 (10.7)
Mood disorder	1 (1.9)	4 (7.1)
Other	4^a(7.4)	3^a(5.4)
No comorbidity	4 (7.4)	9 (16.1)
Number of anxiety disorders per youth (M)	2.36	2.10

1 Notes:ST, student therapist; PT, professional therapist; SAD, separation anxiety disorder; GAD, generalized anxiety disorder; SoP, social phobia; PD, panic disorder; OCD, obsessive compulsive disorder; SP, specific phobia; AP, agoraphobia; CSR, clinician severity rating (ADIS C/P-IV)

2a 4 enuresis

3b 1 sleep terror disorder, 1 selective mutism, 1 enuresis

TABLE 2.

Continuous measure outcomes at pre- and post-treatment for student therapist and professional therapist groups, the time-by-group effect and ES

	Pre –M(SD)	Post –M(SD)	Time-by-group effect	Pre-post ES
ADIS CSR primary diagnosis
ST	6.33 (0.75)	2.85 (2.41)	F_1,108= 0.18,p= 0.72, $η_{p}^{2}$ =0.01	p< 0.001,g= 1.36
PT	6.09 (1.07)	2.16 (2.59)	F_1,108= 0.18,p= 0.72, $η_{p}^{2}$ =0.01	p< 0.001,g= 1.51
ADIS CSR all diagnoses
ST	4.60 (1.32)	2.13 (1.36)	F_1,108= 0.52,p= 0.47, $η_{p}^{2}$ =0.01	p< 0.001,g= 1.82
PT	5.32 (0.95)	1.69 (1.53)	F_1,108= 0.52,p= 0.47, $η_{p}^{2}$ =0.01	p< 0.001,g= 2.52
SCAS youth
ST	41.57 (16.93)	24.13 (14.36)	F_1,108= 0.80,p= 0.37, $η_{p}^{2}$ =0.00	p< 0.001,g= 1.08
PT	39.16 (18.06)	21.57 (14.42)	F_1,108= 0.80,p= 0.37, $η_{p}^{2}$ =0.00	p< 0.001,g= 1.03
SCAS-P mother
ST	43.72 (14.98)	23.76 (11.90)	F_1,108= 1.94,p= 0.27 $η_{p}^{2}$ =0.02	p< 0.001,g= 1.41
PT^a	38.91 (15.79)	22.25 (12.59)	F_1,108= 1.94,p= 0.27 $η_{p}^{2}$ =0.02	p< 0.001,g= 1.12
SCAS-P father
ST	38.18 (15.33)	22.55 (12.57)	F_1,102= 0.00,p= 0.99, $η_{p}^{2}$ =0.00	p< 0.001,g= 1.07
PT	37.15 (13.80)	23.56 (13.87)	F_1,102= 0.00,p= 0.99, $η_{p}^{2}$ =0.00	p< 0.001,g= 0.97
CALIS youth
ST	15.10 (8.09)	7.57 (6.40)	F_1,108= 1.87,p= 0.17, $η_{p}^{2}$ =0.01	p< 0.001,g= 0.99
PT	11.90 (7.35)	7.55 (6.46)	F_1,108= 1.87,p= 0.17, $η_{p}^{2}$ =0.01	p< 0.001,g= 0.61
CALIS mother
ST	19.65 (6.80)	12.06 (7.28)	F_1,108= 1.89,p= 0.17, $η_{p}^{2}$ =0.01	p< 0.001,g= 1.06
PT	17.78 (7.20)	10.61 (7.28)	F_1,108= 1.89,p= 0.17, $η_{p}^{2}$ =0.01	p< 0.001,g= 0.98
CALIS father
ST	18.51 (6.93)	11.90 (6.29)	F_1,102= 1.96,p= 0.17, $η_{p}^{2}$ =0.02	p< 0.001,g= 0.98
PT	16.05 (6.84)	10.96 (7.72)	F_1,102= 1.96,p= 0.17, $η_{p}^{2}$ =0.02	p< 0.001,g= 0.68
CALIS-P mother
ST	13.13 (5.72)	7.26 (5.66)	F_1,108= 1.39,p= 0.24, $η_{p}^{2}$ =0.01	p< 0.001,g= 1.02
PT	11.07 (6.91)	6.82 (6.28)	F_1,108= 1.39,p= 0.24, $η_{p}^{2}$ =0.01	p< 0.001,g= 0.63
CALIS-P father
ST	10.16 (5.65)	6.86 (4.63)	F_1,102= 3.17,p= 0.08, $η_{p}^{2}$ =0.03	p< 0.001,g= 0.62
PT	7.85 (6.09)	5.71 (5.46)	F_1,102= 3.17,p= 0.08, $η_{p}^{2}$ =0.03	p< 0.001,g= 0.32

1 Notes.ST, student therapist; PT, professional therapist; ES, effect-size; ADIS, Anxiety Disorder Interview Schedule for DSM-IV; CSR, Clinician Severity Rating; SCAS, Spence Children’s Anxiety Scale; SCAS-P, Spence Children’s Anxiety Scale Parent version; CALIS, Child Anxiety Life Interference Scale; CALIS-P, Child Anxiety Life Interference Scale – Interference on parents’ life

2a Outlier excluded

TABLE 3.

Continuous measure outcomes at pre- and FU-treatment for the student therapist and professional therapist groups, the time-by-group effect and ES

	Pre –M(SD)	FU -M(SD)	Time-by-group effect	Pre-FU ES
ADIS CSR primary diagnosis
ST	6.33 (0.75)	1.74 (2.31)	F1, 108 = 1.53,p= 0.22, $η_{p}^{2}$ = 0.01	p< 0.01,g= 1.88
PT	6.09 (1.07)	1.59 (2.49)	F1, 108 = 1.53,p= 0.22, $η_{p}^{2}$ = 0.01	p< 0.01,g= 1.81
ADIS CSR all diagnoses
ST	4.60 (1.32)	1.37 (1.22)	F1, 108 = 0.13,p= 0.72, $η_{p}^{2}$ = 0.00	p< 0.01,g= 2.51
PT	5.32 (0.95)	1.28 (1.32)	F1, 108 = 0.13,p= 0.72, $η_{p}^{2}$ = 0.00	p< 0.01,g= 3.27
SCAS youth
ST	41.57 (16.93)	20.91 (12.95)	F1, 108 = 1.47,p= 0.23, $η_{p}^{2}$ = 0.01	p< 0.01,g= 1.30
PT	39.16 (18.06)	16.70 (13.23)	F1, 108 = 1.47,p= 0.23, $η_{p}^{2}$ = 0.01	p< 0.01,g= 1.33
SCAS-P mother
ST	43.72 (14.98)	21.72 (11.53)	F1, 108 = 1.49,p= 0.22, $η_{p}^{2}$ = 0.01	p< 0.01,g= 1.56
PT^a	38.91 (15.79)	19.79 (13.61)	F1, 108 = 1.49,p= 0.22, $η_{p}^{2}$ = 0.01	p< 0.01,g= 1.26
SCAS-P father
ST	38.18 (15.33)	18.70 (12.55)	F1, 102 = 0.00,p= 0.99, $η_{p}^{2}$ = 0.00	p< 0.01,g= 1.34
PT	37.15 (13.80)	18.72 (10.63)	F1, 102 = 0.00,p= 0.99, $η_{p}^{2}$ = 0.00	p< 0.01,g= 1.42
CALIS youth
ST	15.10 (8.09)	8.50 (8.21)	F1, 108 = 3.30,p= 0.07, $η_{p}^{2}$ = 0.03	p< 0.01,g= 0.80
PT	11.90 (7.35)	5.79 (6.07)	F1, 108 = 3.30,p= 0.07, $η_{p}^{2}$ = 0.03	p< 0.01,g= 0.88
CALIS mother
ST	19.65 (6.80)	10.13 (7.09)	F1, 108 = 1.70,p= 0.20, $η_{p}^{2}$ = 0.02	p< 0.01,g= 1.35
PT	17.78 (7.20)	8.80 (7.75)	F1, 108 = 1.70,p= 0.20, $η_{p}^{2}$ = 0.02	p< 0.01,g= 1.18
CALIS father
ST	18.51 (6.93)	8.83 (6.67)	F1, 102 = 0.41,p= 0.53, $η_{p}^{2}$ = 0.00	p< 0.01,g= 1.40
PT	16.05 (6.84)	10.00 (7.85)	F1, 102 = 0.41,p= 0.53, $η_{p}^{2}$ = 0.00	p< 0.01,g= 0.80
CALIS-P mother
ST	13.13 (5.72)	6.39 (5.12)	F1, 108 = 1.10,p= 0.30, $η_{p}^{2}$ = 0.01	p< 0.01,g= 1.22
PT	11.07 (6.91)	5.68 (6.83)	F1, 108 = 1.10,p= 0.30, $η_{p}^{2}$ = 0.01	p< 0.01,g= 0.77
CALIS-P father
ST	10.16 (5.65)	5.27 (5.10)	F1,102 = 2.25,p= 0.14, $η_{p}^{2}$ = 0.02	p< 0.01,g= 0.89
PT	7.85 (6.09)	4.65 (4.77)	F1,102 = 2.25,p= 0.14, $η_{p}^{2}$ = 0.02	p< 0.01,g= 0.56

1 Notes.ST, student therapist; PT, professional therapist; ES, effect-size; ADIS, Anxiety Disorder Interview Schedule for DSM-IV; CSR, Clinician Severity Rating; SCAS, Spence Children’s Anxiety Scale; SCAS-P, Spence Children’s Anxiety Scale Parent version; CALIS,Child Anxiety Life Interference Scale; CALIS-P, Child Anxiety Life Interference Scale - interference on parents life

2a Outlier excluded

Mean scores on SCAS, SCAS-P and CSR primary diagnosis for both treatment groups, at pre-, post-treatment and 3-month follow-up

TABLE 4.

Proportion of youths no longer meeting criteria for primary anxiety diagnosis and all anxiety diagnosis at post-treatment and follow-up

	ST group (n= 54)	PT group (n= 56)	Fischer’s
Post-treatment
Primary diagnosis	50.0% (27)	66.1% (37)	p= 0.122
All diagnosis	25.9% (14)	48.2% (27)	p= 0.019^*
Follow up
Primary diagnosis	74.1% (40)	76.8% (43)	p= 0.826
All diagnosis	46.3% (25)	58.9% (33)	p= 0.252

1 Notes.ST, student therapist; PT, professional therapist

2* Significant atp< 0.05

TABLE 5.

Reliable and clinical significant changes at post-treatment and 3-month follow-up on SCAS, for intention to treat sample

SCAS Youth				SCAS-P Mother			SCAS-P Father
	ST (n= 54)	PT (n= 56)	Fisher’s	ST (n= 54)	PT (n= 56)	Fisher’s	ST (n= 51^a)	PT (n= 53^b)	Fisher’s
Pre-treatment
Over clinical cut-off	75.9% (41)	67.9% (38)	p= 0.40	90.7% (49)	85.7% (48)	p= 0.56	78.4% (40)	84.9% (45)	p= 0.45
Post-treatment
RC deterioration	0% (0)	0% (0)	-	0% (0)	0% (0)	-	0% (0)	1.9% (1)	p= 0.99
RC improvement	63.0% (34)	67.9% (38)	p= 0.69	81.5% (44)	69.6% (39)	p= 0.19	74.5% (38)	71.7% (38)	p= 0.83
RC but not CSC	18.5% (10)	19.6% (11)	p= 0.99	33.3% (18)	12.5% (7)	p= 0.01^*	17.6% (9)	32.1% (17)	p= 0.11
CSC	44.4% (24)	48.2% (27)	p= 0.71	48.1% (26)	57.1% (32)	p= 0.45	56.9% (29)	41.5% (22)	p= 0.17
Three-month follow-up
RC deterioration	0% (0)	5.4% (3)	p= 0.24	5.6% (3)	10.7% (6)	p= 0.49	7.8% (4)	5.7% (3)	p= 0.71
RC improvement	63.0% (34)	50.0% (28)	p= 0.18	77.8% (42)	66.1% (37)	p= 0.21	66.7% (34)	56.6% (30)	p= 0.32
RC but not CSC	3.7% (2)	19.6% (11)	p= 0.02^*	14.8% (8)	28.6% (16)	p= 0.11	21.6% (11)	15.1% (8)	p= 0.45
CSC	59.3% (32)	35.7% (20)	p= 0.02^*	68.5% (37)	48.2% (27)	p= 0.04^*	52.9% (27)	47.2% (25)	p= 0.70

1 Notes: ST, student therapist; PT, professional therapist; RC, reliable change; CSC, clinical significant change; SCAS, Spence Children’s Anxiety Scale; SCAS-P, Spence Children’s Anxiety Scale Parent version.

2a 3 fathers did not participate;

3b 3 fathers did not participate

4* Significant atp< 0.05

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DOI: https://doi.org/10.21307/sjcapp-2019-010 | Journal eISSN: 2245-8875

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Language: English

Page range: 68 - 80

Published on: Nov 20, 2019

Published by: Center for Evidence-based Psychiatry

In partnership with: Paradigm Publishing Services

Publication frequency: 1 issue per year

Keywords:

Anxiety,

children,

adolescents,

Cognitive Behavioral Therapy,

student therapists

Related subjects:

Medicine,

Basic medical science,

Basic medical science, other

© 2019 Daniel Bach Johnsen, Kristian Arendt, Mikael Thastum, published by Center for Evidence-based Psychiatry
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License.

Volume 7 (2019): Issue 1 (January 2019)

The efficacy of manualized Cognitive Behavior Therapy conducted by student-therapists treating Danish youths with anxiety using a benchmark comparison

Figures & Tables

TABLE 1.

TABLE 2.

TABLE 3.

FIGURE 1

TABLE 4.

TABLE 5.

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