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A paper published in the Lancet Psychiatry today compares the clinical efficacy and cost-effectiveness of two brief approaches to treating anxiety in children.

Researchers at the University of Reading and the Health Economics Research Centre at the Nuffield Department of Population Health compared the clinical outcomes and cost-effectiveness of brief guided parent-delivered cognitive behavioural therapy (CBT) and solution-focused brief therapy (a form of counselling that focuses on the present and future and explores a child’s resources and hopes to help build solutions). The study concluded that both interventions were clinically effective. There was no evidence of CBT being clinically superior to brief solution-focused therapy but it was shown to be cost-effective in the short-term.

In a randomised controlled trial at four NHS primary child and mental health services in Oxfordshire children aged between 5 and 12 were randomly allocated to either receive brief parent-delivered CBT or solution focussed brief therapy. The authors noted that as a group the participating families, although representative of many parts of the UK, were highly educated, affluent and not ethnically diverse which they recognised as a limitation of the study.

Families in both groups received roughly five hours of treatment. Parents in the CBT group were given a self-help book and received up to eight weekly sessions of therapist supported brief guided parent-delivered CBT (four face-to-face sessions of 60 minutes and four 15 minute telephone reviews). In the solution-focused brief therapy group the parent and child had an initial hour long face-to-face session with a therapist, then the child had four 45 minute face-to-face therapy sessions, followed by a final one hour session with the therapist, child and parent. The therapists were primary mental health workers from a range of backgrounds including health visiting, nursing, occupational therapy, social and youth work and clinical psychology and psychology graduates. A societal perspective was adopted to assess resource use and costs associated with the two interventions, including all NHS health care and social care services, non-NHS (e.g. educational) services, lost leisure and productivity time estimates for parents.

At the end of treatment 40 children (59%) in the brief guided parent-delivered CBT group had improved compared to 47 children (69%) in the solution-focused brief therapy group. There was no significant difference between the two approaches in clinical or economic outcome measures either at the end of treatment or at the 6 month follow-up assessment. However the CBT intervention was associated with an average saving of £448 per child, mainly due to reduced treatment costs such as lower therapists’ travel expenses because review sessions with parents were conducted by phone, and less time off school or work for children and parents. 

The study concluded that although brief guided parent-delivered CBT was not clinically superior to solution-focused brief therapy, it was likely to represent a cost-effective use of resources compared with solution-focused brief therapy and might be considered as a first-line treatment for children with anxiety problems.