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Comparison of Stepped Care Delivery Against a Single, Empirically Validated Cognitive-Behavioral Therapy Program for Youth With Anxiety: A Randomized Clinical Trial

conference contribution
posted on 01.01.2017, 00:00 authored by R M Rapee, H J Lyneham, V Wuthrich, Mary Lou Chatterton, J L Hudson, M Kangas, Cathy Mihalopoulos
OBJECTIVE: Stepped care is embraced as an ideal model of service delivery but is minimally evaluated. The aim of this study was to evaluate the efficacy of cognitive-behavioral therapy (CBT) for child anxiety delivered via a stepped-care framework compared against a single, empirically validated program. METHOD: A total of 281 youth with anxiety disorders (6-17 years of age) were randomly allocated to receive either empirically validated treatment or stepped care involving the following: (1) low intensity; (2) standard CBT; and (3) individually tailored treatment. Therapist qualifications increased at each step. RESULTS: Interventions did not differ significantly on any outcome measures. Total therapist time per child was significantly shorter to deliver stepped care (774 minutes) compared with best practice (897 minutes). Within stepped care, the first 2 steps returned the strongest treatment gains. CONCLUSION: Stepped care and a single empirically validated program for youth with anxiety produced similar efficacy, but stepped care required slightly less therapist time. Restricting stepped care to only steps 1 and 2 would have led to considerable time saving with modest loss in efficacy. Clinical trial registration information-A Randomised Controlled Trial of Standard Care Versus Stepped Care for Children and Adolescents With Anxiety Disorders;; ACTRN12612000351819.



Association for Behavioral and Cognitive Therapies. Conference (2016 : 50th : New York, New York)


1 - 8




New York, New York

Place of publication

Amsterdam, The Netherlands

Start date


End date





This paper was also published in the Journal of American Academy of Child and Adolescent Psychiatry, Oct 2017 v.56/10 pgs.841-848

Publication classification

E Conference publication; E1 Full written paper - refereed

Copyright notice

2018, Elsevier

Title of proceedings

ABCT 2016 : Proceedings of the 50th Annual Conference of the Association for Behavioral and Cognitive Therapies