Group Exposure CBT With Family and School Involvement for

Group cognitive behavioral therapy (CBT) with family and school involvement was found to be a promising format in the real-world setting for treating anxiety, obsessive-compulsive disorder (OCD) among adolescents, according to results of a study published in Psychiatry Research.

Between 2017 and 2019, adolescents (N=90) with anxiety or OCD were recruited from 2 community mental health clinics in Norway. The CBT program (RISK) comprised 25 hours of group sessions, 10 hours of adolescent-only sessions, and 13 hours of parent-only sessions featuring high exposure therapy and school and homework planning delivered over 10 weeks. Symptom severity was evaluated by the Spencer Child Anxiety Scale (SCAS), the Clinical Global Impression (CGI), and the Clinical Severity Rating of the primary anxiety disorder (CSR1) at baseline, the end of treatment, and at a 12-month follow-up.

Study participants were aged mean 15.29 (SD, 1.32) years, 76.50% were girls, 43.80% lived with both parents, 74.00% had parents who worked full time, and 27.77% had no previous treatment. The diagnoses were social phobia (52.40%), OCD (19%), generalized anxiety disorder (GAD; 13.10%), panic anxiety and/or agoraphobia (8.40%), separation anxiety disorder (4.80%), and specific anxiety disorder (2.40%).

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Treatment discontinuation occurred among 11.1%. Participants who discontinued treatment found therapy too demanding (n=7), had a personal disagreement with another participant (n=1), had travel difficulties (n=1), and received another offer for individual therapy (n=1).

The RISK intervention was associated with improvements to the SCAS Child version (β, 8.56; BF10, 1.1e+8), SCAS Parent version (β, 7.12; BF10, 3.2e+10), CGI (β, 1.46; BF10, 8.4e+37), and CSR1 (β, 1.97; BF10, 3.2e+231).

Posttreatment, 42.3% of participants no longer met the criteria for any anxiety disorder and at 12 months, 79.5% did not meet the criteria.

Posttreatment, remission was more common among individuals with separation anxiety (odds ratio [OR], 3; 95% highest posterior density [HPD], 1.19-7.56) and less likely among those with social anxiety (OR, 0.44; 95% HPD, 0.37-0.51) or GAD (OR, 0.7; 95% HPD, 0.51-0.89).

At 12 months, remission was associated with separation anxiety (OR, 10.1; 95% HPD, 8.43-11.23), OCD (OR, 7.29; 95% HPD, 6.98-7.61), a specific phobia (OR, 7.27; 95% HPD, 6.86-8.07), GAD (OR, 6.36; 95% HPD, 6.15-6.77), panic disorder and/or agoraphobia (OR, 4.62; 95% HPD, 4.47-4.92), and social anxiety (OR, 4.01; 95% HPD, 3.91-4.21).

Stratified by number of RISK sessions, individuals in remission at 12 months attended fewer sessions, indicating that each additional session predicted lower probability of remission (OR, 0.90; 95% HPD, 0.87-0.93).

This study was limited by the lack of randomization or inclusion of a comparator cohort.

“In conclusion, this trial provides support for the use of multi-family, multi-disorder group CBT for adolescent anxiety disorder that includes high exposure to feared situations and high levels of parental and school involvement. A particularly promising result was that only one of the participating adolescents who achieved remission at post-treatment relapsed during the follow-up period, and many participants who had not achieved remission at post-treatment achieved remission during the follow-up period,” stated the study authors.


Bertelsen TB, Wergeland GJ, Nordgreen T, Himle JA, Håland ÅT. Benchmarked effectiveness of family and school involvement in group exposure therapy for adolescent anxiety disorder. Psychiatry Res. 2022;313:114632. doi:10.1016/j.psychres.2022.114632