Society for Social Work and Research

Sixteenth Annual Conference Research That Makes A Difference: Advancing Practice and Shaping Public Policy
11-15 January 2012 I Grand Hyatt Washington I Washington, DC

16825 Do Booster Sessions Boost the Efficacy of Child and Adolescent CBT Treatment: Results From a Meta-Analysis Over 10 Years?

Schedule:
Friday, January 13, 2012: 9:00 AM
Independence B (Grand Hyatt Washington)
* noted as presenting author
RaeHyuck Lee, MSW, Doctoral Student, Columbia University, New York, NY
Robin E. Gearing, PhD, Assistant Professor, Columbia University, New York, NY
Craig S. Schwalbe, PhD, Assistant Professor, Columbia University, New York, NY
Background and Purpose: Do booster sessions improve the efficacy of clinical mental health treatment? Despite that most cognitive behavioral therapy (CBT) intervention studies on childhood and adolescent mental health disorders do not use booster sessions in the treatment, nascent evidence is beginning to recognize that booster sessions may significantly enhance the clinical outcome effects. The purpose of this meta-analysis was to investigate the moderating role of booster sessions in CBT on children and adolescents with internalizing disorders (e.g., anxiety and mood disorders), specifically by examining demographic (e.g., gender, age) and intervention (e.g., treatment modality, number of sessions) characteristics were related to booster sessions.

Methods: A random effects meta-analysis was conducted with RCTs of CBT published from January 1, 2000 December 31, 2009. Forty-nine studies (k=49) that treated children and adolescents with anxiety or mood disorders were analyzed. Information obtained from CBT intervention studies included demographic characteristics (age, gender, race), intervention characteristics (treatment modality, number of sessions, session length in minutes), booster session characteristics (number of booster sessions, time to each booster session), outcome measures, and pre-test/post-test means and standard deviations. Authors and trained research assistants coded data from each article, yielding an inter-rater agreement (>95%) among them. Cohen's d (with CI and I2) was calculated for pre-test/post-test change for each outcome and then yielded a single effect size per study by averaging across outcomes.

Results: Results show that overall CBT treatment of internalizing disorders for youth had large effects on study outcomes (k=49, d=0.90). Specifically, CBT for anxiety disorders yielded larger effects (k=37, d=0.94), whereas CBT for mood disorders showed smaller effects (k=12, d=0.81). However, studies with booster sessions exert substantially larger effects (k=14, d=1.19) than those without booster sessions (k=35, d=0.84). Interaction results found differing effects of booster sessions by demographic and intervention characteristics. Among studies with booster sessions youth from 10 to 13 years-of-age showed 20% larger effects than children (0 to 9 years-of-age) or teens (14 to 17 years-of-age). In studies with more male participants (67% to 100%), booster sessions yielded 20% larger effects than were female-dominated studies (67% to 100%). The interaction of booster sessions by number of sessions (median of 12) evidenced a bimodal distribution, with below and above median categories having higher effects than the median category. A linear trend was detected in the interaction of booster sessions by session length in minutes, showing increasing effects as number of session length increased. Also, in the interaction of booster sessions by intervention modality, effects of family and group modalities were 20% smaller than individual treatment and 50% smaller than mixed treatment. All effect sizes were statistically significant (p<.05).

Implications: Findings can assist in the individual tailoring of CBT interventions for children and adolescents by incorporating booster sessions on according to specific client mental illness presentation and demographics. Overall, findings show that using booster sessions increases the effects of CBT on youth. Booster sessions are therefore recommended for CBT interventions for youth with anxiety and mood disorders. Clinical, research, and policy implications will be explored.

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