Study: Treating youth anxiety has long lasting benefits

A study shows that treating youth anxiety has many beneficial long-lasting benefits for the child. - JR

A study published in the March 2014 issue of the Journal of the American Academy of Child and Adolescent Psychiatry found that the majority of youth with moderate to severe anxiety disorders responded well to acute treatment with cognitive behavioral therapy (CBT), medication (sertraline), or a combination of both. They maintained positive treatment response over a 6 month follow-up period with the help of monthly booster sessions.

As part of the NIMH Child/Adolescent Anxiety Multimodal Study (CAMS), a group of researchers led by Dr. John Piacentini of the UCLA Semel Institute for Neuroscience and Human Behavior, followed 412 children and adolescents ages 7-17 after they completed 12 weeks of acute treatment. Treatment responders were offered 6 additional monthly booster sessions, with those initially on medication continuing this treatment; all youth, regardless of status at week 12, were re-evaluated 3 and 6 months later by trained clinicians. Twenty-seven percent of study participants also reported receiving outside (e.g. nonstudy) psychotherapy and/or medication for mental health symptoms over the 6 month follow-up period.

The study found that over 80% of youth rated as positive responders to one of the three CAMS treatments at Week 12 were also rated as responders at both the 3 and 6 month follow-up evaluations. Conversely, only 5% of youth who received combined CBT plus sertraline, and 15-16% of youth receiving either CBT-only or sertraline-only, failed to achieve responder status at any time during the study. Youth in the combined CBT+sertraline group showed greater treatment benefits on some but not all outcome measures and used less nonstudy treatments than those in the CBT-only and sertraline-only groups.

Collectively, anxiety disorders are the most common mental disorders in children and adolescents. Often overlooked, severe anxiety can significantly impair children's school, social, and family functioning, and if untreated, can increase the risk of depression, alcohol and substance abuse, and occupational difficulties in adulthood.

CAMS is the largest randomized controlled comparative treatment trial for child/adolescent anxiety disorders ever conducted. Participants were recruited at six regionally dispersed sites throughout the United States (UCLA, Duke University, Columbia University/New York University, Johns Hopkins University, Temple University, and the Western Psychiatric Institute and Clinics/University of Pittsburgh) and randomly assigned to 12 weeks of treatment with cognitive behavioral therapy (Coping cat), the selective serotonin reuptake-inhibiting [SSRI] medication sertraline, cognitive behavioral therapy combined with sertraline, or pill placebo. All participants had moderate to severe separation anxiety disorder, generalized anxiety disorder or social phobia, with most having multiple anxiety or other mental health disorders..

"The results of this study provide further evidence of the benefits of cognitive behavioral therapy and SSRI medication, alone or in combination, for treating clinically significant anxiety in children and adolescents," said Dr. Piacentini. "A separate project by the CAMS researchers is now gathering information on how study participants are doing up to 10 years after study participation."

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Ecstasy may help those with Anxiety and PTSD

A study shows that the way Ecstasy acts on the brain could benefit those with anxiety and PTSD.

Researchers say they've discovered how the club drug Ecstasy acts on the brain, and their findings suggest the drug might be useful in treating anxiety and post-traumatic stress disorder.

The study included 25 volunteers who underwent two functional MRI brain scans -- one after taking Ecstasy (MDMA) and one after taking a placebo. Both times, the participants did not know which substance they had been given.

Ecstasy decreased activity in the brain's limbic system, which is involved in emotional responses. The drug also reduced communication between the brain's medial temporal lobe and medial prefrontal cortex, which is involved in emotional control, according to the study, which was published online Jan. 13 in the journal Biological Psychiatry.

These effects are the opposite of brain patterns that occur in people with anxiety, said the researchers, from Imperial College London, in England.

The researchers also found that Ecstasy increased communication between the amygdala and the hippocampus. Previous research has shown that people with post-traumatic stress disorder (PTSD) have reduced communication between these brain areas.

"We found that MDMA caused reduced blood flow in regions of the brain linked to emotion and memory," study author Dr. Robin Carhart-Harris, of the department of medicine, said in a college news release. "These effects may be related to the feelings of euphoria that people experience on the drug."

"In healthy volunteers, MDMA seems to lessen the impact of painful memories," Carhart-Harris said. "This fits with the idea that it could help patients with PTSD revisit their traumatic experiences in psychotherapy without being overwhelmed by negative emotions, but we need to do studies in PTSD patients to see if the drug affects them in the same way."

Another researcher advised caution in applying the study results to other groups of people.

"The findings suggest possible clinical uses of MDMA in treating anxiety and PTSD, but we need to be careful about drawing too many conclusions from a study in healthy volunteers," study co-leader David Nutt, a professor of neuropsychopharmacology, said in the news release. "We would have to do studies in patients to see if we find the same effects."

A recent pilot study in the United States investigated the use of MDMA along with psychotherapy in the treatment of PTSD patients and yielded positive results, the researchers said.

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