List of ongoing research

1. We have recently completed a randomized wait-list controlled trial of the efficacy of a manualized group CBT treatment for children and young people with anxiety disorders, the 10 session “Cool Kids”/”Chilled” treatment program. The program has previously been evaluated by Rapee and his co-workers with encouraging results, but our study is the first independent trial, and the first trial of manualized treatment of children and adolescents with anxiety disorders in Denmark. We included 110 children, 55 in the treatment condition and 55 in the wait list control condition. We are in the process of analysing the full dataset, The study is planned to be published shortly after the last one-year follow-up data has been collected.

2. Despite the efficacy of CBT for childhood anxiety as demonstrated by randomized controlled trials, including our own, a substantial proportion of children does not benefit, or only partially benefit from CBT. In our study, 20 % of the children were not or only minimally improved 3 months after the treatment. As part of our study the non-responders are offered individualized case formulation based treatment based on a check list of factors hypothesized to contribute to the non-response, and a revised case formulation. The analysis of the data will result in a series of casestudies.

3. It is a challenge to implement evidence based treatment in routine clinical practice. As part of our research, we are evaluating the outcomes of the Cool Kids program, when delivered in outpatient Child and Adolescent Psychiatry units or in a community based School Counselling Service in Denmark. Psychologists and psychiatrists from three Child and Adolescent Psychiatry clinics and four community based School Counselling Services have been trained and supervised in the Cool Kids program by our clinic. We are measuring the results by independent diagnostic interviews with the children and their parents as well as by self-report child and parent scales at pre- and post-treatment and at 3-month follow-up. Data collection with a total of 92 children has now finished.

4. Only a small proportion of children with anxiety disorders receive treatment, despite evidence of the efficacy of cognitive-behavioural therapy for treating children with anxiety disorders. Bibliotherapy is a low cost therapy with minimal therapist assistance, which in a few studies has been shown to result in favorable outcomes compared to waitlist and outcomes comparable to face-to-face treatment. In an ongoing study we examine the efficacy of therapist supported bibliotherapy compared with face-to-face group treatment in children aged 8-12. We expect to finish data collection with a total of 80 children by December 2013.

5. Cognitive information processing biases has been demonstrated in anxious children similar to those found with anxious adults but effects are often inconsistent and it is unclear at what age and how these biases appear and whether they are a vulnerability factor. Also little is known about whether cognitive distortion and dysfunction in anxious children are stable over time, whether cognitive dysfunction predicts treatment response or whether eventual changes are associated with treatment response. We are conducting a study on neuro- and metacognitive markers and predictors for treatment response in children with anxiety and OCD in collaboration with Psychiatric Hospital for Children and Adolescents, Risskov. Inclusion is expected to continue until May 2014.

7. We are conducting a study on norms and psychometric properties of the self-rating scale, Spence Children’s Anxiety Scale (SCAS) developed to assess anxiety symptoms in children using both children and parents reports. The SCAS is the primary self-report measure for child anxiety in the wait-list RCT described above, and it is therefore relevant to conduct a study to assess the psychometric properties of the scale as well as establish Danish non-clinical norms for both children and parents. Data was collected from 4 schools in 3 different municipalities and included children in the age 7-17 years as well as both parents. To assess retest-reliability of the scale, 10 % of the participants were asked to complete the scale a second time 2 weeks after the initial test while another 10 % of the participants were asked to complete the scale again 3 months after the initial test. Data collection has finished and the study is planned to be published in 2013.

8. We are currently analyzing data and writing up the results of a study on psychometric properties of the self-rating scale Rearing Behaviour Questionnaire (RBQ), developed to assess parenting behaviors using both children and parents reports. The RBQ scale has so far only been tested within a non-clinical sample. We included this scale in our RCT study described above, and apart from evaluating its psychometric properties and factor structure, our paper will be the first one to evaluate its usefulness within a clinical sample of anxious children.

9. Anxiety disorders are under genetic influence but almost nothing is known about specific genes involved. We also know relatively little about specific factors involved in response to CBT. We are part of a multinational study aiming to identify specific genetic markers associated with child anxiety disorders, and to examine multiple predictors of CBT response in anxious children, including specific genes. Principal investigator of this study is Dr Talya Eley, Institute of Psychiatry, King's College, London.

10. Lately there has been an increase in the development and use of internet based cognitive behavioral therapy programs (ICBT), as a means to reduce costs and enhance accessibility of psychological interventions. ICBT has proven efficacious towards adults with anxiety disorders. Research in the field of ICBT with children and adolescents is still in its infancy though and to date, no program targeting anxiety disorders has been developed nor evaluated in Denmark. From the perspective of a stepped care model, an internet based version of the Chilled Adolescents Anxiety program, a manualized CBT intervention originally developed and evaluated at Macquarie University, Australia, is now being translated, revised and pilot tested at The Anxiety Clinic. In 2015 we will examine the efficacy of the program compared to a wait list condition in a randomized controlled trial.

11. Remembering the past and imagining the future in children with anxiety disorders. ­Previous research has shown how children remember their past and imagine their future. These studies have shown that children remember their past, but especially imagine their future, as very positive. It has also been found that older children use the cultural life script, especially when they imagine the future. The present study investigates how children and youth with anxiety disorders remember their past and imagine their future compared to children and youth from a primary school. The purpose of this study is to gain greater knowledge about anxiety, but also to shed light on the possible long term outcomes of cognitive behavioral therapy. In the study children and youth aged 10-17 years participate. The participants are all attending the Educational University Clinic for anxiety disorders at Aarhus University. The way these children remember their past and imagine their future is examined before and after they receive cognitive behavioral therapy at the Educational University Clinic. For further information please contact: Stine Ramsgaard.