Rapee, R. M. (2000). Group treatment of children with anxiety disorders: Outcome and predictors of treatment response. Australian Journal of Psychology, 52(3), 125–129. https://doi.org/10.1080/00049530008255379

Type of Study: Pretest–posttest study with a nonequivalent control group (Quasi-experimental)
Number of Participants: 95

Population:

• Age — 7–16 years
• Race/Ethnicity — 100% Caucasian
• Gender — 56 Female and 39 Male
• Status — Participants were parents and children with anxiety disorders who presented following media publicity about child anxiety, referral from general practitioners and school counselors, or word of mouth communication about the program.

Location/Institution: Macquarie University Child and Adolescent Anxiety Clinic

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to evaluate the outcomes from a nine-session group treatment [now called Cool Kids Anxiety Program - Therapist-Led Delivery]. Participants were either part of the group treatment or a wait list control group. Measures utilized include the Anxiety Disorders Interview Schedule (ADIS-CP), the Revised Children’s Manifest Anxiety Scale (RCMAS), the Fear Survey Schedule – Revised (FSSC-R), the Child Behavior Checklist (CBCL), the Beck Anxiety Inventory (BAI), the Beck Depression Inventory (BDI), and the Dyadic Adjustment Scale (DAS). Results indicate that children in the intervention group improved significantly more on several measures of anxiety than did waiting-list controls. The improvements maintained and, in several cases increased, at 1-year follow-up. Limitations include the lack of randomization to the intervention, control groups, and lack of generalizability due to ethnicity.

Length of controlled postintervention follow-up: 1 year (intervention group only).

Rapee, R. M., Abbott, M. J., & Lyneham, H. J. (2006). Bibliotherapy for children with anxiety disorders using written materials for parents: A randomized controlled trial. Journal of Consulting and Clinical Psychology, 74(3), 436–444. https://doi.org/10.1037/0022-006X.74.3.436

Type of Study: Randomized controlled trial
Number of Participants: 267

Population:

• Age — 6–12 years
• Race/Ethnicity — 100% Caucasian
• Gender — 61% Male and 39% Female
• Status — Participants were parents with children diagnosed with anxiety disorders who were referred through school counselors, general practitioners, or mental health professionals.

Location/Institution: Macquarie University Anxiety Research Unit

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to examine the value of modifying an empirically validated treatment for childhood anxiety for application via written materials for parents of anxious children. Participants were randomly allocated to standard group treatment [now called Cool Kids Anxiety Program - Therapist-Led Delivery], waitlist, or a bibliotherapy version of treatment for childhood anxiety. Measures utilized include the Anxiety Disorders Interview Schedule for Children and Parents (ADIS-CP), the Spence Children’s Anxiety Scale (SCAS), the Children’s Automatic Thoughts Scale (CATS), and the parent version of the SCAS and the Child Behavior Checklist (CBCL). Results indicate that in general, parent bibliotherapy demonstrated benefit for treatment children relative to waitlist, but was not as efficacious as standard group treatment. Relative to waitlist, use of written materials for parents with no therapist contact resulted in around 15% more children being free of an anxiety disorder diagnosis after 12 and 24 weeks. Limitations include the sample came from a traditional, specialist anxiety clinic, lack of generalizability due to ethnicity, and length of follow-up. 

Length of controlled postintervention follow-up: 3 months.

Hudson, J. L., Rapee, R. M., Deveney, C., Schniering, C. A., Lyneham, H. J., & Bovopoulous, N. (2009). Cognitive-behavioral treatment versus an active control for children and adolescents with anxiety disorders: A randomized trial. Journal of the American Academy of Child and Adolescent Psychiatry, 48(5), 533–544. https://doi.org/10.1097/CHI.0b013e31819c2401

Type of Study: Randomized controlled trial
Number of Participants: 112

Population:

• Age — 7–16 years
• Race/Ethnicity — 89% Caucasian and 11% Asian
• Gender — 64 Male and 48 Female
• Status — Participants were parents and children with a principal anxiety disorder not including depressive symptoms.

Location/Institution: Center for Emotional Health, Department of Psychology, Macquarie University

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to examine whether a specific cognitive-behavioral treatment package (CBT) [now called Cool Kids Anxiety Program - Therapist-Led Delivery] was more efficacious in treating childhood anxiety disorders than a nonspecific support package [group support and attention (GSA)]. Participants were randomly allocated to either the CBT or the GSA control condition. Measures utilized include the Anxiety Disorders Interview Schedule (ADIS-CP), the self-reported Spence Children’s Anxiety Scale (SCAS), and the Strengths and Difficulties Questionnaire (SDQ). Results indicate that CBT was significantly more efficacious compared with the GSA condition: 68.6% of children in the CBT condition did not meet diagnostic criteria for their principal anxiety diagnosis at 6-month follow-up compared with 45.5% of the children in the GSA condition. The results of the child- and parent-completed measures indicated that mothers of CBT children reported significantly greater treatment gains than mothers of GSA children, and children reported similar improvements across conditions. Limitations include a significant lack of congruence between parent and child reports, lack of generalizability due to ethnicity, and length of follow up

Length of controlled postintervention follow-up: 3 months.

McLoone, J. K., & Rapee, R. M. (2012). Comparison of an anxiety management program for children implemented at home and school: Lessons learned. School Mental Health, 4(4), 231–242. https://doi.org/10.1007/s12310-012-9088-7

Type of Study: Randomized controlled trial
Number of Participants: 152

Population:

• Age — Children: 8–13 years(Mean=9.63–9.77 years); Parents: Mean=40–43 years
• Race/Ethnicity — Not specified
• Gender — Children: Home-based: 43% Male, School-based: 37% Male, and Waitlist: 29% Male; Parents: Not specified
• Status — Participants were parents and their children in grades 2 through 6.

Location/Institution: 11 schools located within metropolitan, Sydney, Australia

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to investigate the feasibility of delivering an early intervention program for the management of child anxiety [now called Cool Kids Anxiety Program - Therapist-Led Delivery] in either a school- or home setting, relative to a waitlist-control condition. Participants were randomly allocated to the following three conditions: school-based treatment, home-based treatment, and monitoring only. Measures utilized include the Spence Children’s Anxiety Scale (SCAS), the Children’s Automatic Thoughts Scale (CATS), the Spence Children’s Anxiety Scale-parent version (SCASp), the Child Anxiety Life Interference Scale (CALIS), the Depression, Anxiety Stress Scales (DASS), the Barriers to Treatment Participation Scale, the School Anxiety Scale (SAS), and the Strengths and Difficulties Questionnaire (SDQ). Results indicate that children participating in the active conditions; home-based and school-based interventions showed significantly greater reductions in anxiety and anxiety-related interference in daily life, compared to the waitlist-control group according to parents’ reports. In contrast, reports from children and teachers failed to show significant group differences on measures of anxiety. Limitations include lack of independent assessment, parents not blind to child’s study condition, and high attrition rate.

Length of controlled postintervention follow-up: 9 months.

Hudson, J. L., Newall, C., Rapee, R. M., Lyneham, H. J., Schniering, C. C., Wuthrich, V. M., Schneider, S., Seeley-Wait, E., Edwards, S., & Gar, N. S. (2014). The impact of brief parental anxiety management on child anxiety treatment outcomes: A controlled trial. Journal of Clinical Child & Adolescent Psychology, 43(3), 370–380. https://doi.org/10.1080/15374416.2013.807734

Type of Study: Randomized controlled trial
Number of Participants: 209

Population:

• Age — Children: 6–13 years; Mothers: Mean=41.1–42.6 years; Fathers: Mean=42.7–45.0 years
• Race/Ethnicity — Children: 90% Caucasian; Parents: Not specified
• Gender — Children: 104 Female; Parents: Not specified
• Status — Participants were children meeting criteria for a principal diagnosis of an anxiety disorder.

Location/Institution: Not specified

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to examine whether the addition of a brief parental anxiety management (BPAM) program to family cognitive behavioral therapy (CBT) [now called Cool Kids Anxiety Program - Therapist-Led Delivery] was more efficacious than CBT alone in treating childhood anxiety disorders. Participants were randomly allocated to CBT with a five-session program of BPAM or CBT alone. Measures utilized include the Anxiety Disorder Interview Schedule for Children—Child and Parent version (ADIS-IV-C/P), the Spence Children’s Anxiety Scale, and Protocol Adherence Checklist–Modified. Results indicate that the addition of BPAM to CBT did not significantly improve outcomes for the child, or the parent compared to the CBT alone group at posttreatment or at follow-up. Overall, however, children with non-anxious parents were more likely to be diagnosis free for any anxiety disorder compared to children with anxious parents at posttreatment and follow-up. BPAM did not produce greater reductions in parental anxiety. Limitations include concerns about the generalizability of the study due to the limited racial/ethnic diversity, the reliance on self-report questionnaire measures to determine parental anxiety, and the lack of a no treatment or waitlist control group.

Length of controlled postintervention follow-up: 6 months.

Chavira, D. A., Drahota, A., Garland, A. F., Roesch, S., Garcia, M., & Stein, M. B. (2014). Feasibility of two modes of treatment delivery for child anxiety in primary care. Behaviour Research and Therapy, 60, 60–66. https://doi.org/10.1016/j.brat.2014.06.010

Type of Study: Randomized controlled trial
Number of Participants: 48

Population:

• Age — Children: FF: Mean=9.75 years and TSB: Mean=9.75 years; Parents: FF: Mean=41.69 years and TSB: Mean=42.31 years
• Race/Ethnicity — Children: FF: 83% Caucasian, 13% Multicultural, and 8% Latino; TSB: 63% Caucasian, 21% Multicultural, and 13% Latino; Parents: Not specified
• Gender — Children: FF: 58% Female and TSB: 54% Female; Parents: Not specified
• Status — Participants were children and their parents recruited from primary care clinics.

Location/Institution: Not specified

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to evaluate the feasibility of cognitive behavior therapy (CBT) [now called Cool Kids Anxiety Program - Therapist-Led Delivery] for children with anxiety in primary care. Participants were randomly assigned to receive either CBT delivered by a child anxiety specialist in the primary care clinic (FF), or implemented by the parent with therapist support by telephone (TSB). Measures utilized include the Anxiety Disorders Interview Schedule for Children (ADIS-C-IV), Screen for Anxiety and Related Disorders (SCARED), the Clinical Global Impression Scale - Improvement (CGI-I), Children’s Global Assessment Scale (C-GAS), the Parent Consumer Satisfaction Scale, and the Barriers to Treatment Participation Scales. Results indicate that according to the CGI-I, 58.3%–75% of participants were considered responders (i.e., much or very much improved) at the various time points. Similar patterns were found for remission from “primary anxiety disorder” and “all anxiety disorders” as defined by the ADIS. Clinically significant improvement was seen on the various parent and child self-report measures of anxiety. Limitations include small sample size, lack of generalizability due to ethnicity and education level of participants, lack of no treatment control group, and length of follow-up.

Length of controlled postintervention follow-up: 3 months.

Arendt, K., Thastum, M., & Hougaard, E. (2016). Efficacy of a Danish version of the Cool Kids program: a randomized wait–list controlled trial. Acta Psychiatrica Scandinavica, 133(2), 109–121. https://doi.org/10.1111/acps.12448

Type of Study: Randomized controlled trial
Number of Participants: 109

Population:

• Age — 7–16 years, GCBT: Mean=11.82 years; Wait-List: Mean=11.73 years
• Race/Ethnicity — Not specified
• Gender — GCBT: 56% Female; Wait-List: 59% Female
• Status — Participants were children and adolescents with a primary anxiety disorder diagnosis.

Location/Institution: Department of Psychology and Behavioural Sciences, Aarhus University, Denmark

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to evaluate the efficacy of a Danish version of the Cool Kids [now called Cool Kids Anxiety Program - Therapist-Led Delivery] program for anxiety disorders among children and adolescents. Participants were randomly allocated to Cool Kids or a wait list (WL). Measures utilized include the Anxiety Disorders Interview Schedule for Children (ADIS-C-IV), Spence Children’s Anxiety Scale (SCAS), Spence Children’s Anxiety Scale – Parent Version (SCAS-P), Child Anxiety Life Interference Scale (CALIS), Mood and Feelings Questionnaire (S-MFQ), Becks Youth Inventories (BYI), Experience of Service Questionnaire (ESQ), Children’s Automatic Thought Scale (CATS), Self-Efficacy Questionnaire for Children (SEQ), Depression Anxiety Stress Scales (DASS) for parents, Rearing Behavior Questionnaire (RBQ), Clinical Global Impression – Improvement Scale (CGI-I) and the Children’s Global Assessment Scale (C-GAS). Results indicate that the Danish version of the Cool Kids program was efficacious with 48.2% free of all anxiety diagnoses at posttreatment, compared with 5.7% in the WL condition, and large effect sizes on self-report measures of child anxiety symptoms rated by child, mother, and father were found. Children and adolescents in the Cool Kids group improved further from posttreatment to 3-month follow-up and this improvement was maintained at 12-month follow-up. Participants with a primary diagnosis of social phobia (SoP) showed less improvement compared with other anxiety diagnoses. Limitations include that the treatment was compared to WL and not to an active control condition, and the 12-month follow-up analyses excluded 12 participants due to their inclusion in another study on individualized treatment of non-responders

Length of controlled postintervention follow-up: 3 and 12 months (intervention only).

Rapee, R. M., Lyneham, H. J., Wuthrich, V., Chatterton, M. L., Hudson, J. L., Kangas, M., & Mihalopoulos, C. (2017). Comparison of stepped care delivery against a single, empirically validated cognitive-behavioral therapy program for youth with anxiety: A randomized clinical trial. Journal of the American Academy of Child & Adolescent Psychiatry, 56(10), 841–848. https://doi.org/10.1016/j.jaac.2017.08.001

Type of Study: Randomized controlled trial
Number of Participants: 281

Population:

• Age — 6–17 years, empirically validated treatment: Mean=9.10 years; SC: Mean=9.42 years
• Race/Ethnicity — Not specified
• Gender — Empirically validated treatment: 57% Female; SC: 49% Female
• Status — Participants were youth with anxiety disorders.

Location/Institution: Macquarie University

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to evaluate the efficacy of cognitive-behavioral therapy (CBT) for child anxiety delivered via a stepped-care framework (SC) compared to an empirically validated treatment [now called Cool Kids Anxiety Program - Therapist-Led Delivery]. Participants were randomly allocated to receive either the empirically validated treatment or SC involving the following: (1) low intensity, (2) standard CBT, and (3) individually tailored treatment. Measures utilized include the Anxiety Disorders Interview Schedule for DSM-IV, the Parent and Child versions (ADIS-IV-CP), the Spence Children’s Anxiety Scale (SCAS), and the Spence Children’s Anxiety Scale – Parent Version (SCAS-P). Results indicate that interventions did not differ significantly on any outcome measures. Total therapist time per child was significantly shorter to deliver SC (774 minutes) compared with the empirically validated treatment (897 minutes). Within SC, the first 2 steps returned the strongest treatment gains. Limitations include concerns about generalizability, as the study was conducted in a university clinic and subjects were relatively wealthy, well educated, and of limited ethnic diversity; and the movement between steps was an arbitrary decision, and different results might have emerged using a different set of stepping criteria, such as diagnostic status or questionnaire cut-off scores.

Length of controlled postintervention follow-up: None.

Haugland, B. S. M., Haaland, Å. T., Baste, V., Bjaastad, J. F., Hoffart, A., Rapee, R. M., Raknes, S., Himle, J. A., Husabø, E., & Wergeland, G. J. (2020). Effectiveness of brief and standard school-based cognitive behavioral interventions for adolescents with anxiety: A randomized noninferiority study. Journal of the American Academy of Child and Adolescent Psychiatry, 59(4), 522–564. https://doi.org/10.1016/j.jaac.2019.12.003

Type of Study: Randomized controlled trial
Number of Participants: 313

Population:

• Age — 12–16 years (Mean=14.00 years)
• Race/Ethnicity — Not specified
• Gender — 84% Female
• Status — Participants were adolescents recruited through school health services.

Location/Institution: Norway

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to examine the effectiveness of targeted school-based cognitive-behavioral therapy (CBT) for adolescents (12–16 years of age) with anxiety [now called Cool Kids Anxiety Program - Therapist-Led Delivery] and test whether brief CBT was non-inferior to standard duration CBT. Participants were randomly allocated to brief (5 sessions, comprising 5.5 hours),  standard CBT (10 sessions, comprising 15 hours), or 10 weeks waitlist (WL). Immediately following the WL, participants were randomized to either brief or standard CBT. Assessments were conducted pre- and post-intervention, post-WL, and at 1-year follow-up. Measures utilized include the Spence Children’s Anxiety Scale (SCAS), the Child Anxiety Life Interference Scale, the Short Moods and Feelings Questionnaire (SMFQ), and the Clinical Global Impression Scale-Severity (CGI-S). Results indicate that targeted school-based CBT significantly reduced adolescents’ anxiety symptoms with small to moderate effect sizes compared to WL. According to the parents, adolescents impairment from anxiety were significantly reduced compared to WL. Pre- to post-changes in anxiety symptoms were small to moderate. Although no significant differences in effects were found between brief and standard CBT, brief CBT was not non-inferior to standard CBT. Outcomes from both interventions were sustained at 1-year follow-up. Limitations include diagnostic evaluation was not included, making it impossible to know the “true preventive effects” of the interventions, that is, the ability to prevent anxiety disorders among participants; potential bias related to the clinical severity ratings, which were completed by the group leaders who also delivered the interventions; the absence of an external independent evaluation of the youths’ symptoms and impairment; no teacher reports of classroom behavior; and randomization did not occur at the school level.

Length of controlled postintervention follow-up: 1 year (intervention group only).

Rapee, R. M., Lyneham, H. J., Wuthrich, V., Chatterton, M. L., Hudson, J. L., Kangas, M., & Mihalopoulos, C. (2021). Low intensity treatment for clinically anxious youth: A randomised controlled comparison against face-to-face intervention. European Child & Adolescent Psychiatry, 30(7), 1071–1079. https://doi.org/10.1007/s00787-020-01596-3

Type of Study: Randomized controlled trial
Number of Participants: 281

Population:

• Age — 6–16 years (Mean=9.26 years)
• Race/Ethnicity — Not specified
• Gender — 53% Female
• Status — Participants were children and youth with an anxiety disorder diagnosis.

Location/Institution: The Centre for Emotional Health at Macquarie University

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to compare the efficacy of low-intensity and traditional face-to-face delivery of a standard cognitive behavioral intervention for anxious youth [now called Cool Kids Anxiety Program - Therapist-Led Delivery]. Participants were randomly allocated to treatment delivered either face-to-face (Cool Kids) or in a low-intensity format. Measures utilized include the Anxiety Disorders Interview Schedule for DSM-IV, Parent and Child versions (ADIS-IV-CP), the Youth Online Diagnostic Assessment (YODA), the Spence Children’s Anxiety Scale, Parent and Child versions (SCAS-C; SCAS-P), and the Child Anxiety Life Interference Scale (CALIS). Results indicate that youth receiving the face-to-face intervention were significantly more likely to have symptoms decrease from all anxiety disorders than youth receiving the low-intensity treatment. This difference was reflected in parents’ (but not the child’s) reports of the child’s anxiety symptoms and life interference. Low-intensity delivery utilized significantly less total therapist time than face-to-face delivery, and this was reflected in a large mean difference in therapy costs. The standard face-to-face intervention is associated with significantly better outcomes than delivery of the same treatment using low-intensity methods. However, the size of this difference was relatively small. In contrast, low-intensity delivery requires markedly less time from therapists and subsequently lower treatment costs. Limitations include that despite the relatively large sample, the study did not have sufficient power to thoroughly evaluate moderators of outcomes, and that the results cannot be generalized to those with lower socio-economic status or parents with limited education.

Length of controlled postintervention follow-up: None.