Effectiveness of Group CBT on Internalizing and Externalizing Symptoms in Children with Mixed Psychiatric Disorders

Background: Our study addressed the gap in research on the effectiveness of cognitive behavioral therapy (CBT) in treating children with mixed psychiatric disorders. We examined the immediate and long-term effects of group CBT (GCBT), delivered in naturalistic clinical settings, on reducing internalizing and externalizing symptoms in children with mixed psychiatric disorders. Further, we compared the effectiveness of cost-effective, manualized GCBT to treatment as usual (TAU) consisting of individually tailored psychiatric outpatient services delivered by mental health care specialists. Methods: Children aged 6–12 years (n = 103) diagnosed with psychiatric disorders, more than 70% with psychiatric comorbidity, were assigned either directly to GCBT (GCBT group; n = 52) or TAU for approximately 3 months, after which they received GCBT (TAU + GCBT group; n = 51). Internalizing and externalizing symptoms were assessed using parent- and teacher-report questionnaires (Child Behavior Checklist and Teacher Report Form) at referral to treatment, pre-treatment, post-treatment, and six-month follow-up. Results: Parent- and teacher-rated internalizing symptoms and parent-rated externalizing symptoms were reduced immediately after GCBT. Long-term GCBT gains were prominent for parent-rated externalizing symptoms. No differences were observed between the effectiveness of GCBT and TAU. Conclusions: Our results suggest that GCBT and TAU services are equally effective in treating internalizing and externalizing symptoms in children with mixed psychiatric disorders, providing support for the broader use of cost-effective manualized GCBT. Manualized GCBT, which requires relatively short training, can also be delivered at primary healthcare levels. Our results are of relevance to cost-effectiveness and global mental health staff shortages.