Parent-Led CBT

Question 1

Cartwright-Hatton et al (2011)

Answer 1

RCT with children <10 with waitlist vs parent-only condition, showing significant reductions in child anxiety when CBT interventions delivered via parents

Question 2

Full vs Brief Guided Parent-Led CBT (GPD-CBT) Content

Answer 2

Full - weekly therapist contact over 8 weeks, with 4 sessions face-to-face and 4 brief telephone reviews

Brief - same time period but fortnightly, with 2 face-to-face and 2 telephone sessions, total period time of 5h20

Question 3

Thirlwall et al (2013)

Answer 3

RCT comparing full GPD-CBT versus brief GPD-CBT versus waitlist in 194 children with current AD, but non-AD parent (due to poorer outcomes in intensive CBT; Hudson et al., 2014)

Full GPD-CBT superior diagnostic outcomes compared with waitlist at posttreatment, whereas brief did not > 50% in full remission, 25% in waitlist, and 39% in brief, with full rising to 75% at 6mo follow-up

Concluded full GPD-CBT effective and inexpensive first-line low-intensity treatment

Question 4

Creswell et al (2017)

Answer 4

Compared clinical outcomes (CGI-I) and cost-effectiveness (QALYs) of brief GPD-CBT and solution-focused brief therapy (widely used in NHS with few sessions) in RCT

No significant differences between groups in either clinical or economic outcome measures, similar to CAMS study (Walkup et al., 2008) and meta-analyses (James et al., 2013), but GPD-CBT associated with lower costs and when accounting for sampling uncertainty, likely to represent cost-effective intervention

Question 5

Thirlwall et al (2017)

Answer 5

Assessed predictors of treatment response in Thirlwall et al (2013)

Non-AD parents of 125 children with AD received GPD-CBT over 2.6 or 5.3h

Younger children and those with GAD improved more posttreatment, but older children and those without primary GAD better outcomes 6mo follow-up; fewer children allocated to 2.6h recovered posttreatment compared to 5.2h, but no significant differences 6mo later

None of 15 variables investigated significantly predicted outcomes (consistent with literature of now reliable predictors of treatment success), but key changes in trajectory seen

For young vs old results, perhaps parents find it easier to implement strategies from intervention with younger children, may take longer for older

Question 6

Creswell et al (2023)

Answer 6

Looked at brief parent-led CBT for child ADs and discussed challenges

10/11 RCTs found clear evidence of effectiveness, with 5/8 studies finding outcomes at least as good as child/parent-child treatment, with evidence of cost-effectiveness

Highlighted therapist concerns such as (1) concern in parents’ ability to implement strategies, but tackle this by reinforcing evidence-base and background on parent-led CBT to them e.g., tackling mechanisms; Murray et al (2009); (2) lack of experience working with parents, but qualitative interviews from Thirlwall et al (2013) showed parents found approach acceptable and therapists performed well (although here therapists all had specialist training, not the case in routine practice)