A non-inferiority randomised controlled trial comparing the clinical and cost-effectiveness of one session treatment (OST) with multi-session cognitive behavioural therapy (CBT) in children with specific phobias

Record ID 32016000882
Authors' objectives: A specific phobia is a type of anxiety disorder which causes an overwhelming and unbearable fear and avoidance of whatever is causing the fear, for example, an animal, situation or activity. It estimated that between 5% and 10% of children have a specific phobia which impacts on their everyday lives and lasts for an average of about 20 years. Despite this, fewer than 10% report asking for help for their phobia but do use medical care for other things at a higher rate than most other anxiety disorders. Specific phobias can cause considerable problems at school or college, personal distress, and interference in day-to-day activities. Cognitive Behavioural Therapy is the most successful treatment for anxiety disorders and phobias however it is expensive in terms of time. Additionally people need to attend for several sessions which may lead to them not completing all the sessions. As a result, services are moving towards low intensity treatments with the potential to be implemented across the NHS. A promising alternative, One Session Therapy (OST), has been shown to be successful but has yet to be examined with children. Therefore there is a need to test whether simple phobias severe enough to interfere with daily functioning can be successfully treated using a single session CBT which is less expensive and time consuming. To answer this we plan to compare a single session CBT treatment with multi-session CBT. Single session CBT combines graduated exposure to the source of fear, alongside strategies for managing fear and promote coping. It has been shown to be particularly helpful with alleviating specific phobias. Multi-session CBT is a commonly offered treatment which involves both cognitive (e.g. addressing unhelpful patterns of thinking) and behavioural (e.g. exposure) aspects. The main difficulty of carrying out this comparison will be to recruit the large number of children (aged 7-16) with a specific phobia that impacts their daily lives. We will supplement standard recruitment through referrals to child mental health and IAPT services with more active recruitment techniques through schools and primary care. We will recruit from 5 locations: Sheffield, Leeds, York, Norfolk and the North East IAPT area. To help us get the number of people that we need we will screen children in schools using the fear survey schedule and the Child Anxiety Impact Scale, to ensure that we identify the children most in need of help. To support this recruitment, we plan to recognise and include the frequency and complexity of other illness in children with specific phobias. Once recruited, children will be randomly allocated to receive either one session or multi session CBT. We will ask them their treatment preferences which will not affect their allocation but will allow us to examine the impact of patient preference. The main thing we will test will be to see how close the children can get to whatever it is that they are afraid of, measured on the Behavioural Approach Test. This will be assessed before starting treatment and again at 6 months. We will also look at how severe their phobia is clinically, how scared they rate themselves, their quality of life and the impact that their fear has.
Project Status: Ongoing
Anticipated Publish Date: 2021
English language abstract: An English language summary is available
Publication Type: Not Assigned
Country: England
MeSH Terms
  • Cognitive Behavioral Therapy
  • Child
  • Cost-Benefit Analysis
  • Phobic Disorders
Organisation Name: NIHR Health Technology Assessment programme
Contact Address: NIHR Journals Library, National Institute for Health Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK
Contact Name: journals.library@nihr.ac.uk
Contact Email: journals.library@nihr.ac.uk
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