Remission More Important than Response in Children with Anxiety

Remission and response are two different measures used to gauge how well a client responds to treatment for anxiety disorders (AD). Children, in particular, are usually evaluated based on how their symptoms have improved, known as response. Remission, however, is a term used to describe the absence of symptoms altogether. “An important question for clinicians, patients, and families is, what are the chances of becoming nearly symptom free?” asked Golda S. Ginsburg of the Division of Child and Adolescent Psychiatry at the Johns Hopkins University School of Medicine in Maryland. Because the majority of randomized controlled trials (RCTs) use response rates to gauge their results, Ginsburg wanted to examine how the RCTs fared based on remission. “Identifying remission rates in RCTs is thus an important index of treatment outcome.”

In a recent study, Ginsburg assessed the remission rates in children who were part of a larger study on anxiety, the Child/Adolescent Anxiety Multimodal Study (CAMS). The participants underwent one of four 12 week treatment protocols including, cognitive behavioral therapy (CBT), medication (sertraline SRT), a combination of both (COMB), or a placebo with treatment as usual. “Using diagnostic status as a rigorous definition of remission (i.e., no longer meeting criteria for any of the three primary ADs treated in this study), children randomized to the COMB condition had significantly higher remission rates than did children in any of the other treatment conditions,” said Ginsburg. “Findings also indicated that remission rates for the entire sample were significantly lower than response rates.” She added, “Given the relatively large sample size of the CAMS, these results help clarify important and clinically relevant predictors of remission.” Ginsburg believes that “identifying the mechanisms of change in CBT and in SRT and working toward optimizing these change strategies early in treatment may prove fruitful in maximizing the potential for remission.” She further added, “Given that the treatment providers in the CAMS were highly trained and continuously supervised, the need to improve current treatments for anxious youth may be even greater for clinical practice in community settings.”

Reference:
Ginsburg, Golda S., Phillip C. Kendall, Dara Sakolsky, Scott N. Compton, John Piacentini, Anne Marie Albano, John T. Walkup, Joel Sherrill, Kimberly A. Coffey, Moira A. Rynn, Courney P. Keaton, James T. McCracken, Lindsey Bergman, Satish Iyengar, Boris Birmaher, and John March. “Remission after Acute Treatment in Children and Adolescents with Anxiety Disorders: Findings from the CAMS.” Journal of Consulting and Clinical Psychology 79.6 (2011): 806-13. Print.

© Copyright 2011 by By Noah Rubinstein, LMFT, LMHC, therapist in Olympia, Washington. All Rights Reserved. Permission to publish granted to GoodTherapy.org.

The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the preceding article can be directed to the author or posted as a comment below.

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  • Justine Phelps

    Justine Phelps

    December 21st, 2011 at 12:00 AM

    I hate to think of little children suffering from anxiety. When did this become so prevalent? Anxiety was to my mind an issue that adults dealt with, not little children. I’m glad to hear that it’s possible for them to go into remission! I hope they never have it return.

  • Sarah

    Sarah

    December 21st, 2011 at 2:44 PM

    I agree with Justine.
    Yes there were times in my childhood where I can remember being worried about things- a test or whatever- but never anything that in hindsight that was all that serious.
    But now you find kids are completely shut down with fear and anxiety, they get worried sick over the least little things!
    That can’t really be healthy for their future mental or physical health to be experiencing this so early in life.

  • matt

    matt

    December 23rd, 2011 at 1:18 PM

    of course the subsidization of symptoms does mean recovering…and I’m surprised to know there is any different between response and remission coz they usually go hand in hand.

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