One session treatment (OST) is equivalent to multi-session cognitive behavioral therapy (CBT) in children with specific phobias (ASPECT): results from a national non-inferiority randomized controlled trial

Barry Wright; Lucy Tindall; Alexander J Scott; Ellen Lee; Cindy Cooper; Katie Biggs; Penny Bee; Han-I Wang; Lina Gega; Emily Hayward; Kiera Solaiman; M Dawn Teare; Thompson Davis; Jon Wilson; Karina Lovell; Dean McMillan; Amy Barr; Hannah Edwards; Jennifer Lomas; Chris Turtle; Steve Parrott; Catarina Teige; Tim Chater; Rebecca Hargate; Shezhad Ali; Sarah Parkinson; Simon Gilbody; David Marshall

doi:10.1111/jcpp.13665

One session treatment (OST) is equivalent to multi-session cognitive behavioral therapy (CBT) in children with specific phobias (ASPECT): results from a national non-inferiority randomized controlled trial

Barry Wright, Lucy Tindall, Alexander J Scott, Ellen Lee, Cindy Cooper, Katie Biggs, Penny Bee, Han-I Wang, Lina Gega, Emily Hayward, Kiera Solaiman, M Dawn Teare, Thompson Davis, Jon Wilson, Karina Lovell, Dean McMillan, Amy Barr, Hannah Edwards, Jennifer Lomas, Chris TurtleSteve Parrott, Catarina Teige, Tim Chater, Rebecca Hargate, Shezhad Ali, Sarah Parkinson, Simon Gilbody, David Marshall

Research output: Contribution to journal › Article › peer-review

Abstract

BACKGROUND: 5%-10% children and young people (CYP) experience specific phobias that impact daily functioning. Cognitive Behaviour Therapy (CBT) is recommended but has limitations. One Session Treatment (OST), a briefer alternative incorporating CBT principles, has demonstrated efficacy. The Alleviating Specific Phobias Experienced by Children Trial (ASPECT) investigated the non-inferiority of OST compared to multi-session CBT for treating specific phobias in CYP.

METHODS: ASPECT was a pragmatic, multi-center, non-inferiority randomized controlled trial in 26 CAMHS sites, three voluntary agency services, and one university-based CYP well-being service. CYP aged 7-16 years with specific phobia were randomized to receive OST or CBT. Clinical non-inferiority and a nested cost-effectiveness evaluation was assessed 6-months post-randomization using the Behavioural Avoidance Task (BAT). Secondary outcome measures included the Anxiety Disorder Interview Schedule, Child Anxiety Impact Scale, Revised Children's Anxiety Depression Scale, goal-based outcome measure, and EQ-5DY and CHU-9D, collected blind at baseline and six-months.

RESULTS: 268 CYPs were randomized to OST (n = 134) or CBT (n = 134). Mean BAT scores at 6 months were similar across groups in both intention-to-treat (ITT) and per-protocol (PP) populations (CBT: 7.1 (ITT, n = 76), 7.4 (PP, n = 57), OST: 7.4 (ITT, n = 73), 7.6 (PP, n = 56), on the standardized scale-adjusted mean difference for CBT compared to OST -0.123, 95% CI -0.449 to 0.202 (ITT), mean difference -0.204, 95% CI -0.579 to 0.171 (PP)). These findings were wholly below the standardized non-inferiority limit of 0.4, suggesting that OST is non-inferior to CBT. No between-group differences were found on secondary outcomes. OST marginally decreased mean service use costs and maintained similar mean Quality Adjusted Life Years compared to CBT.

CONCLUSIONS: One Session Treatment has similar clinical effectiveness to CBT for specific phobias in CYP and may be a cost-saving alternative.

Original language	English
Journal	Journal of Child Psychology and Psychiatry
Early online date	1 Aug 2022
DOIs	https://doi.org/10.1111/jcpp.13665
Publication status	E-pub ahead of print - 1 Aug 2022

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10.1111/jcpp.13665Licence: CC BY

One session treatment (OST) is equivalent to multi-session cognitive behavioral therapy (CBT) in childrenwith specific phobias (ASPECT): results from anational non-inferiority randomized controlled trial
© 2022 The Authors.
Final published version, 719 KBLicence: CC BY

Cite this

Wright, B., Tindall, L., Scott, A. J., Lee, E., Cooper, C., Biggs, K., Bee, P., Wang, H.-I., Gega, L., Hayward, E., Solaiman, K., Teare, M. D., Davis, T., Wilson, J., Lovell, K., McMillan, D., Barr, A., Edwards, H., Lomas, J., ... Marshall, D. (2022). One session treatment (OST) is equivalent to multi-session cognitive behavioral therapy (CBT) in children with specific phobias (ASPECT): results from a national non-inferiority randomized controlled trial. Journal of Child Psychology and Psychiatry. Advance online publication. https://doi.org/10.1111/jcpp.13665

@article{db4a68baf69b4e5a943ff26f6717bd21,

title = "One session treatment (OST) is equivalent to multi-session cognitive behavioral therapy (CBT) in children with specific phobias (ASPECT): results from a national non-inferiority randomized controlled trial",

abstract = "BACKGROUND: 5%-10% children and young people (CYP) experience specific phobias that impact daily functioning. Cognitive Behaviour Therapy (CBT) is recommended but has limitations. One Session Treatment (OST), a briefer alternative incorporating CBT principles, has demonstrated efficacy. The Alleviating Specific Phobias Experienced by Children Trial (ASPECT) investigated the non-inferiority of OST compared to multi-session CBT for treating specific phobias in CYP.METHODS: ASPECT was a pragmatic, multi-center, non-inferiority randomized controlled trial in 26 CAMHS sites, three voluntary agency services, and one university-based CYP well-being service. CYP aged 7-16 years with specific phobia were randomized to receive OST or CBT. Clinical non-inferiority and a nested cost-effectiveness evaluation was assessed 6-months post-randomization using the Behavioural Avoidance Task (BAT). Secondary outcome measures included the Anxiety Disorder Interview Schedule, Child Anxiety Impact Scale, Revised Children's Anxiety Depression Scale, goal-based outcome measure, and EQ-5DY and CHU-9D, collected blind at baseline and six-months.RESULTS: 268 CYPs were randomized to OST (n = 134) or CBT (n = 134). Mean BAT scores at 6 months were similar across groups in both intention-to-treat (ITT) and per-protocol (PP) populations (CBT: 7.1 (ITT, n = 76), 7.4 (PP, n = 57), OST: 7.4 (ITT, n = 73), 7.6 (PP, n = 56), on the standardized scale-adjusted mean difference for CBT compared to OST -0.123, 95% CI -0.449 to 0.202 (ITT), mean difference -0.204, 95% CI -0.579 to 0.171 (PP)). These findings were wholly below the standardized non-inferiority limit of 0.4, suggesting that OST is non-inferior to CBT. No between-group differences were found on secondary outcomes. OST marginally decreased mean service use costs and maintained similar mean Quality Adjusted Life Years compared to CBT.CONCLUSIONS: One Session Treatment has similar clinical effectiveness to CBT for specific phobias in CYP and may be a cost-saving alternative.",

author = "Barry Wright and Lucy Tindall and Scott, {Alexander J} and Ellen Lee and Cindy Cooper and Katie Biggs and Penny Bee and Han-I Wang and Lina Gega and Emily Hayward and Kiera Solaiman and Teare, {M Dawn} and Thompson Davis and Jon Wilson and Karina Lovell and Dean McMillan and Amy Barr and Hannah Edwards and Jennifer Lomas and Chris Turtle and Steve Parrott and Catarina Teige and Tim Chater and Rebecca Hargate and Shezhad Ali and Sarah Parkinson and Simon Gilbody and David Marshall",

note = "{\textcopyright} 2022 The Authors.",

year = "2022",

month = aug,

day = "1",

doi = "10.1111/jcpp.13665",

language = "English",

journal = "Journal of Child Psychology and Psychiatry",

issn = "0021-9630",

publisher = "Wiley-Blackwell",

}

Wright, B , Tindall, L, Scott, AJ, Lee, E, Cooper, C, Biggs, K, Bee, P, Wang, H-I , Gega, L, Hayward, E, Solaiman, K, Teare, MD, Davis, T, Wilson, J, Lovell, K, McMillan, D, Barr, A, Edwards, H, Lomas, J, Turtle, C, Parrott, S , Teige, C, Chater, T, Hargate, R, Ali, S, Parkinson, S, Gilbody, S & Marshall, D 2022, 'One session treatment (OST) is equivalent to multi-session cognitive behavioral therapy (CBT) in children with specific phobias (ASPECT): results from a national non-inferiority randomized controlled trial', Journal of Child Psychology and Psychiatry. https://doi.org/10.1111/jcpp.13665

One session treatment (OST) is equivalent to multi-session cognitive behavioral therapy (CBT) in children with specific phobias (ASPECT): results from a national non-inferiority randomized controlled trial. / Wright, Barry ; Tindall, Lucy; Scott, Alexander J et al.
In: Journal of Child Psychology and Psychiatry, 01.08.2022.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - One session treatment (OST) is equivalent to multi-session cognitive behavioral therapy (CBT) in children with specific phobias (ASPECT)

T2 - results from a national non-inferiority randomized controlled trial

AU - Wright, Barry

AU - Tindall, Lucy

AU - Scott, Alexander J

AU - Lee, Ellen

AU - Cooper, Cindy

AU - Biggs, Katie

AU - Bee, Penny

AU - Wang, Han-I

AU - Gega, Lina

AU - Hayward, Emily

AU - Solaiman, Kiera

AU - Teare, M Dawn

AU - Davis, Thompson

AU - Wilson, Jon

AU - Lovell, Karina

AU - McMillan, Dean

AU - Barr, Amy

AU - Edwards, Hannah

AU - Lomas, Jennifer

AU - Turtle, Chris

AU - Parrott, Steve

AU - Teige, Catarina

AU - Chater, Tim

AU - Hargate, Rebecca

AU - Ali, Shezhad

AU - Parkinson, Sarah

AU - Gilbody, Simon

AU - Marshall, David

PY - 2022/8/1

Y1 - 2022/8/1

N2 - BACKGROUND: 5%-10% children and young people (CYP) experience specific phobias that impact daily functioning. Cognitive Behaviour Therapy (CBT) is recommended but has limitations. One Session Treatment (OST), a briefer alternative incorporating CBT principles, has demonstrated efficacy. The Alleviating Specific Phobias Experienced by Children Trial (ASPECT) investigated the non-inferiority of OST compared to multi-session CBT for treating specific phobias in CYP.METHODS: ASPECT was a pragmatic, multi-center, non-inferiority randomized controlled trial in 26 CAMHS sites, three voluntary agency services, and one university-based CYP well-being service. CYP aged 7-16 years with specific phobia were randomized to receive OST or CBT. Clinical non-inferiority and a nested cost-effectiveness evaluation was assessed 6-months post-randomization using the Behavioural Avoidance Task (BAT). Secondary outcome measures included the Anxiety Disorder Interview Schedule, Child Anxiety Impact Scale, Revised Children's Anxiety Depression Scale, goal-based outcome measure, and EQ-5DY and CHU-9D, collected blind at baseline and six-months.RESULTS: 268 CYPs were randomized to OST (n = 134) or CBT (n = 134). Mean BAT scores at 6 months were similar across groups in both intention-to-treat (ITT) and per-protocol (PP) populations (CBT: 7.1 (ITT, n = 76), 7.4 (PP, n = 57), OST: 7.4 (ITT, n = 73), 7.6 (PP, n = 56), on the standardized scale-adjusted mean difference for CBT compared to OST -0.123, 95% CI -0.449 to 0.202 (ITT), mean difference -0.204, 95% CI -0.579 to 0.171 (PP)). These findings were wholly below the standardized non-inferiority limit of 0.4, suggesting that OST is non-inferior to CBT. No between-group differences were found on secondary outcomes. OST marginally decreased mean service use costs and maintained similar mean Quality Adjusted Life Years compared to CBT.CONCLUSIONS: One Session Treatment has similar clinical effectiveness to CBT for specific phobias in CYP and may be a cost-saving alternative.

AB - BACKGROUND: 5%-10% children and young people (CYP) experience specific phobias that impact daily functioning. Cognitive Behaviour Therapy (CBT) is recommended but has limitations. One Session Treatment (OST), a briefer alternative incorporating CBT principles, has demonstrated efficacy. The Alleviating Specific Phobias Experienced by Children Trial (ASPECT) investigated the non-inferiority of OST compared to multi-session CBT for treating specific phobias in CYP.METHODS: ASPECT was a pragmatic, multi-center, non-inferiority randomized controlled trial in 26 CAMHS sites, three voluntary agency services, and one university-based CYP well-being service. CYP aged 7-16 years with specific phobia were randomized to receive OST or CBT. Clinical non-inferiority and a nested cost-effectiveness evaluation was assessed 6-months post-randomization using the Behavioural Avoidance Task (BAT). Secondary outcome measures included the Anxiety Disorder Interview Schedule, Child Anxiety Impact Scale, Revised Children's Anxiety Depression Scale, goal-based outcome measure, and EQ-5DY and CHU-9D, collected blind at baseline and six-months.RESULTS: 268 CYPs were randomized to OST (n = 134) or CBT (n = 134). Mean BAT scores at 6 months were similar across groups in both intention-to-treat (ITT) and per-protocol (PP) populations (CBT: 7.1 (ITT, n = 76), 7.4 (PP, n = 57), OST: 7.4 (ITT, n = 73), 7.6 (PP, n = 56), on the standardized scale-adjusted mean difference for CBT compared to OST -0.123, 95% CI -0.449 to 0.202 (ITT), mean difference -0.204, 95% CI -0.579 to 0.171 (PP)). These findings were wholly below the standardized non-inferiority limit of 0.4, suggesting that OST is non-inferior to CBT. No between-group differences were found on secondary outcomes. OST marginally decreased mean service use costs and maintained similar mean Quality Adjusted Life Years compared to CBT.CONCLUSIONS: One Session Treatment has similar clinical effectiveness to CBT for specific phobias in CYP and may be a cost-saving alternative.

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DO - 10.1111/jcpp.13665

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JO - Journal of Child Psychology and Psychiatry

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