Examining the clinical efficacy and acceptability of personalised treatment for childhood anxiety disorders based on children's cognitive-learning risk markers

Anxiety disorders are the earliest emerging, most common and debilitating mental illnesses, yet 40-45% of anxious children do not respond to best-practice psychological treatment, cognitive-behavioural therapy (CBT). For the past two decades, we have been examining fear conditioning and extinction (CON-EXT) markers of anxious children’s underlying threat sensitivity, positive valence, and cognitive control systems, and the markers that predict who will recover following CBT. We have developed a CON-EXT Profile to assess markers at the individual patient level and conducted studies of CBT enhancements that allow for personalised treatment. The next and most important step is to examine outcomes from personalised CBT relative to standard CBT. The primary aim of this project is to conduct a Phase III randomised controlled trial, in which anxious children, 7-12 years of age, are randomised to Stratified CBT, in which CBT is personalised to their CON-EXT markers (right CBT for each anxious child), compared to Standard CBT, in which anxious children receive standard CBT (one size fits all). It is hypothesised that a higher proportion of children will be in remission, and acceptability ratings and treatment completions will be higher, in Stratified CBT than Standard CBT at the post-treatment primary endpoint and 6-month follow-up.