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Two case studies by Lundkvist-Houndoumadi and Thastum (2013a, 2013b) describe the use of the Cool Kids cognitive behavioral therapy program for anxious children and their parents, which was conducted at their Clinic at the University of Aarhus in Denmark. In providing our reactions to these two fascinating and illuminating articles, we first familiarize readers with the Cool Kids program, including both its nature, range, and evidence base. This is followed by a discussion of some relevant issues and complications in doing therapy with anxious children that are illustrated by these case studies, including the motivation of both anxious children and their parents; the therapeutic role of exposure to anxious situations; a modular approach to accommodate individual variation; group versus individual format; directly addressing parental anxiety problems; and the cost-effectiveness of treatment. [ABSTRACT FROM AUTHOR]

Objective: The aim of the present study was to determine the efficacy of an Internet-based clinician-assisted computerized cognitive behavioural treatment (CaCCBT) programme for depression. Method: Forty-five individuals meeting diagnostic criteria for depression were randomly assigned to the Sadness programme or to a waitlist control group. In the clinician-assisted Sadness programme, participants complete six online lessons, weekly homework assignments, receive weekly email contact from a clinical psychologist, and contribute to a moderated online discussion forum with other participants. An intention-to-treat model was used for data analyses. Results: A total of 20 (74%) treatment group participants completed all lessons within the 8 week programme, and post-treatment data were collected from 18/27 treatment group and 17/18 waitlist group participants. Treatment group participants reported significantly reduced symptoms of depression as measured by the Beck Depression Inventory-second edition and the Patient Health Questionnaire-Nine Item. Treatment group participants each received an average of eight email contacts (111 min of therapist time]. Mean within- and between-group effect sizes (Cohen's d) across the two measures of depressive symptoms were 0.98 and 0.75, respectively. Participants found the treatment programme acceptable and satisfactory. Conclusions: These results replicate those from the pilot trial reported by Perini et al. and are consistent with literature indicating that Internet-based programmes for depression and other mental disorders combined with clinical guidance can result in clinically significant improvements. These data provide further support for the development of Internet-based treatment for common mental disorders. [ABSTRACT FROM AUTHOR]

Abstract: Objective: The purpose of this study was to compare a newly developed screening measure of disability, the WHODAS II, to three established generic effectiveness measures in terms of its sensitivity to symptom change in people with anxiety disorders. Method: Patients who had undergone treatment for social phobia or panic disorder/agoraphobia at an anxiety disorders clinic were administered generic effectiveness measures and symptom measures before and after treatment. The design was naturalistic and observational. Data analysis included correlations between generic effectiveness and symptom measures; and effect size calculations regarding the ability of each generic effectiveness measure to discriminate between patients whose symptoms improved and patients whose symptoms did not improve over the course of treatment. Results: The WHODAS II was consistently the most sensitive generic effectiveness measure in its capacity to detect symptom changes in patients with social phobia. The SF-12 and K-10 also showed moderate sensitivity to symptom change. In the sample of patients with panic disorder/agoraphobia, the SF-12 was the most sensitive measure overall, closely followed by the K-10 and WHODAS II. The NCS Disability Days were the least sensitive to symptom change in both samples. Conclusion: The WHODAS II is at least as sensitive as other generic effectiveness measures to anxiety symptom changes, and is particularly sensitive to changes in social anxiety symptoms. It may prove to be a valuable measurement tool for informing public health policy in relation to anxiety disorders. [Copyright &y& Elsevier]

Importance: Personalized treatment choices would increase the effectiveness of internet-based cognitive behavioral therapy (iCBT) for depression to the extent that patients differ in interventions that better suit them., Objective: To provide personalized estimates of short-term and long-term relative efficacy of guided and unguided iCBT for depression using patient-level information., Data Sources: We searched PubMed, Embase, PsycInfo, and Cochrane Library to identify randomized clinical trials (RCTs) published up to January 1, 2019., Study Selection: Eligible RCTs were those comparing guided or unguided iCBT against each other or against any control intervention in individuals with depression. Available individual patient data (IPD) was collected from all eligible studies. Depression symptom severity was assessed after treatment, 6 months, and 12 months after randomization., Data Extraction and Synthesis: We conducted a systematic review and IPD network meta-analysis and estimated relative treatment effect sizes across different patient characteristics through IPD network meta-regression., Main Outcomes and Measures: Patient Health Questionnaire-9 (PHQ-9) scores., Results: Of 42 eligible RCTs, 39 studies comprising 9751 participants with depression contributed IPD to the IPD network meta-analysis, of which 8107 IPD were synthesized. Overall, both guided and unguided iCBT were associated with more effectiveness as measured by PHQ-9 scores than control treatments over the short term and the long term. Guided iCBT was associated with more effectiveness than unguided iCBT (mean difference [MD] in posttreatment PHQ-9 scores, -0.8; 95% CI, -1.4 to -0.2), but we found no evidence of a difference at 6 or 12 months following randomization. Baseline depression was found to be the most important modifier of the relative association for efficacy of guided vs unguided iCBT. Differences between unguided and guided iCBT in people with baseline symptoms of subthreshold depression (PHQ-9 scores 5-9) were small, while guided iCBT was associated with overall better outcomes in patients with baseline PHQ-9 greater than 9., Conclusions and Relevance: In this network meta-analysis with IPD, guided iCBT was associated with more effectiveness than unguided iCBT for individuals with depression, benefits were more substantial in individuals with moderate to severe depression. Unguided iCBT was associated with similar effectiveness among individuals with symptoms of mild/subthreshold depression. Personalized treatment selection is entirely possible and necessary to ensure the best allocation of treatment resources for depression.